A holdout no more, Sen. Ben Nelson agreed Saturday to provide the 60th and deciding vote for sweeping healthcare legislation in the Senate, capping a year of struggle and a final burst of deadline bargaining on President Barack Obama's top domestic priority.
Nelson, D-Neb., said he made his decision after winning fresh concessions to limit the availability of abortions in insurance sold in newly created exchanges, as well as tens of millions in federal Medicaid funds for his home state.
"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," he said at a news conference in the Capitol, referring to the abortion issue. "But I would not have voted for this bill without these provisions."
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He also noted he had successfully fended off attempts to provide for a government-run insurance option to compete with private insurers.
One Democratic official said an analysis by the Congressional Budget Office to be released later Saturday would estimate a deficit savings of more than $130 billion over 10 years, and the possibility of much more in the subsequent decade.
Forecasters said the bill would expand coverage to roughly 94 percent of eligible Americans under age 65, a total that excludes illegal immigrants. The official who described the conclusions spoke on condition of anonymity, saying he lacked authorization to pre-empt the release of the report.
With Nelson's decision, Obama's Senate allies appear on track to pass the legislation by Christmas, overcoming unanimous Republican opposition and a swirling early winter snowstorm.
At its core, the measure is designed to spread coverage to tens of millions who lack it, while banning insurance company practices such as denial of coverage on the basis of pre-existing medical conditions. The White House also wants the legislation that eventually makes it through Congress to slow the rate of growth in national medical spending overall. The House passed its version of the legislation last month, and final compromise talks are expected quickly.
Nelson disclosed his decision as Majority Leader Harry Reid, D-Nev., unveiled a final series of changes designed to solidify support.
The legislation includes new limits designed to limit insurance company profits and overhead, by requiring them to spend 80 percent of their premium income on medical care for individual insurance policies, and 85 percent for group policies. The industry says such a limitation is unnecessary because profits generally are in the single digits.
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. Those plans would be privately owned, but operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.
The option amounts to a consolation prize for liberals, who failed to include a government-run alternative.
Additionally, insurance companies would be barred immediately from denying coverage to children because of a pre-existing health condition. The prohibition on denial of coverage for adults would not take effect in the Senate bill until 2014, a disappointment for consumer advocates.
On abortion, the measure would let a state disallow coverage in new insurance exchanges by passing a law to that effect. Additionally, it sets up a mechanism to segregate funds that would be used to pay for abortions from federal subsidy dollars flowing to health plans.
Federal law now prohibits public money for abortions, except in cases of rape, incest or to save the life of the mother. From the beginning, the issue has been how those restrictions would be applied to a new stream of federal money under the overhaul bill.
The developments occurred as Republicans dug in to delay the inevitable for as long as possible. They objected when Reid sought permission for Nelson to announce his decision in a speech on the Senate floor, then forced Senate clerks to spend hours reading aloud the text of the 383-page package of changes.
Republican opposition, coupled with Senate rules requiring 60 votes to overcome a filibuster, gave Nelson enormous leverage as he pressed for concessions that included stronger restrictions on abortions to be covered by insurance policies offered in a newly overhauled health care system.
The final agreement with Nelson was sealed late Friday night after marathon negotiations in Reid's Capitol office a few steps off the Senate floor. Reid telephoned Obama with the news.
Officials said the federal government would pick up Nebraska's entire cost of a Medicaid expansion in the bill. Other states will have to begin picking up a portion of the added expanse beginning in 2017.
Nelson already rejected one proposed offer on abortions as insufficient, and the presence in the talks of Sen. Barbara Boxer, D-Calif., indicated additional changes were on the table.
Boxer has a strong record in favor of abortion rights. She told reporters as she left the Capitol at the end of Friday evening there had been progress made on the issue of separating personal funds, which may be used to pay for abortions, from federal dollars, which may not.
The issue is contentious because the legislation provides federal subsidies to help lower and middle-income families afford insurance and the other federal health care programs ban the use of government money to pay for abortions.
Gone from the bill is a tax on cosmetic surgical procedures, including Botox injections. Instead, Senate Democrats are proposing a 10 percent sales tax on tanning salons, to be paid by the person soaking up the rays. The Food and Drug Administration says ultraviolet radiation from tanning can increase the risk of skin cancer.
Obama devoted his weekend radio and Internet address to the issue he campaigned on in 2008.
"Now — for the first time — there is a clear majority in the Senate that's willing to stand up to the insurance lobby and embrace lasting health insurance reforms that have eluded us for generations," Obama said.
In the Republican response, Sen. John McCain warned that rushing through legislation now would do more harm than good.
"The best thing government could do to ensure more Americans have access to health care insurance is to institute reforms that would rein in costs and make health care more affordable," said McCain, R-Ariz.
In an article she wrote in Saturday's Washington Post, Vicki Kennedy, the widow of Sen. Ted Kennedy, D-Mass., said that while the Senate bill is imperfect, it would achieve many of the goals her husband fought for over four decades.
"I humbly ask his colleagues to finish the work of his life, the work of generations, to allow the vote to go forward and to pass health care reform now. As Ted always said, when it's finally done, the people will wonder what took so long," she said.
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