WASHINGTON – Jubilant Democrats locked in Nebraska Sen. Ben Nelson as the 60th and decisive vote for historic health care legislation Saturday, putting President Barack Obama’s signature issue firmly on a path for Christmas Eve passage.
In the Capitol, Senate Majority Leader Harry Reid smiled broadly when asked if Nelson’s decision gave him the 60-vote majority necessary to overcome solid Republican opposition. The Nevada Democrat agreed to a series of concessions on abortion and other issues demanded by Nelson in daylong talks on Friday, then informed Obama of the agreement in a late night phone call as the president flew home from climate talks in Copenhagen.
The Congressional Budget Office said the Senate bill would extend coverage to more than 30 million Americans who lack it. Most Americans would be required to purchase insurance, with federal subsidies available to help defray the cost for lower and middle income individuals and families.
In a concession to Nelson and other moderates, the bill lacks a government-run insurance option of the type that House Democrats inserted into theirs. “This bill is a legislative train wreck of historic proportions,” the party’s leader, Sen. Mitch McConnell of Kentucky, said at a news conference. He pointed to cuts to Medicare that CBO said totaled more than $470 billion over a decade, with reductions in planned payments to home health care agencies and hospices. He also said the bill includes “massive tax increases” at a time of double-digit unemployment.
Republicans also noted that CBO concluded that under the bill, “federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care.”
True to their word, Republicans objected when Reid sought permission for Nelson to announce his decision in a speech on the Senate floor, then insisted clerks read aloud 383 pages of last-minute changes the majority leader unveiled.
Many of Reid’s revisions were designed to secure the 60 votes needed to steer the bill past the GOP filibuster.
Those drafted at Nelson’s behest drew the most attention, and included further restrictions on abortion coverage in policies sold inside the exchanges.
In states where such coverage is permitted, consumers must notify their insurance company they want it, and pay for it separately.
The Nebraskan also won increased federal funds to cover his state’s cost of covering an expanded Medicaid population at a cost that one Democratic official put at $45 million over a decade, and took credit for easing the bill’s impact as well as other, smaller changes.
Rep. Bart Stupak, D-Mich., who pushed through the restrictions in the House-passed bill, also rejected Nelson’s deal. He called it “not acceptable” because it “would allow the federal government to subsidize insurance policies with abortion coverage.” He said he intends to keep working to find a solution that would allow him to ultimately vote for the health care bill.

Nelson, Nebraska’s former state insurance commissioner, wasn’t the only squeaky senatorial wheel within the 60-member Democratic caucus.

Sanders made an impassioned speech on the Senate floor earlier in the week on behalf of a doomed proposal for government-run health care. Numerous issues must be resolved — including the role of government in the new insurance market and abortion restrictions. In place of a government-run insurance option, the estimated 30 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Insurance companies would be barred immediately from denying coverage to children because of a pre-existing health condition. Among the changes Reid incorporated was dropping a proposed tax on cosmetic surgical procedures, including Botox injections. The revised bill also calls for a .9 percent increase in the Medicare payroll tax on incomes over $200,000 for individuals and $250,000 for couples. Reid’s earlier bill had a smaller hike, .5 percent.

The bill also taxes high-cost insurance plans as part of a plan to put downward pressure on health care use.

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