Democrats Clinch Deal for Deciding Vote on Health Bill

WASHINGTON — Senate Democrats said Saturday that they had clinched an agreement on a far-reaching overhaul of the nation’s health care system and forged ahead with efforts to approve the legislation by Christmas over Republican opposition.
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Sen. Ben Nelson, right, agreed after hours of negotiation Friday to back the Senate Democrats’ legislation, making him the pivotal 60th vote.

As the Senate convened in a blizzard, Democratic leaders hailed a breakthrough that came when Senator Ben Nelson, Democrat of Nebraska, agreed to back the bill after 13 hours of negotiations on Friday, making him the pivotal 60th vote for a measure that President Obama has called his top domestic priority.

“Change is never easy, but change is what’s necessary in America,” Mr. Nelson said at a morning news conference. “And that’s why I intend to vote,” he said, “for health care reform.”

Mr. Obama, appearing on television from the White House, said: “Today is a major step forward for the American people. After nearly a century-long struggle, we are on the cusp of making health care reform a reality in the United States of America.”

The legislation, the most significant overhaul of the nation’s health care system in more than a generation, seeks to extend health benefits to more than 30 million uninsured Americans.

The blinding snow outside the Capitol added to what had already been a chaotic few weeks for the Senate, which has met every day since Nov. 30 and was working through its third consecutive weekend. The sergeant-at-arms had four-wheel-drive vehicles at the ready to bring lawmakers in for votes. And while senators wore the jackets and ties required on the Senate floor, dress shoes gave way to boots.

Mr. Nelson committed his vote after winning tighter restrictions on insurance coverage for abortions, as well as increased federal health care aid for his state.

With Senate leaders increasingly confident that they would pass the bill, Mr. Nelson pointedly warned that he would oppose the final version if negotiations with the House, which approved its bill last month, result in changes that he does not like.

But House liberals are expected to resist some concessions made in the Senate. To secure the votes of centrist holdouts, Senate leaders dropped a proposed government-run health insurance plan, or public option, and an alternate plan to let some people ages 55 to 65 buy coverage through Medicare, both favored by liberals.

Because the Democrats nominally control 60 seats in the Senate — the precise number needed to overcome a Republican filibuster — every senator in the Democratic caucus effectively has veto power over the bill. No Republican is willing to support it.

“The lines are drawn,” said Senator Richard M. Burr, Republican of North Carolina. “He has to get 60 votes. If he doesn’t get 60 votes, the American people win. If he does get them, America’s payback will come in the form of the 2010 elections.”

Not all Democrats have publicly said they will vote for the bill, but Senate leaders and senior White House officials believe they have agreement.

“All Senate Democrats stand shoulder to shoulder with President Obama and the American people, who know that inaction is not an option,” the majority leader, Senator Harry Reid of Nevada, said at a news conference.

Faced with Republican resistance that many Democrats saw as driven more by politics than policy disagreements, Senate Democrats in recent days gained new determination to bridge differences among themselves and prevail over the opposition.

Lawmakers who attended a private meeting between Mr. Obama and Senate Democrats at the White House on Tuesday pointed to remarks there by Senator Evan Bayh, Democrat of Indiana, as providing some new inspiration.

Mr. Bayh said that the health care measure was the kind of public policy he had come to Washington to work on, according to officials who attended the session, and that he did not want to see the satisfied looks on the faces of Republican leaders if they succeeded in blocking the measure.

The measure would extend health benefits by expanding Medicaid and providing subsidies to help moderate-income people buy private insurance. It would require nearly all Americans to obtain insurance or pay financial penalties for failing to do so.

By redrawing the health care sector, the legislation stands to reshape roughly one-sixth of the American economy.

The nonpartisan Congressional Budget Office said the legislation would cost $871 billion over 10 years, with the expense more than offset by revenues from new taxes and fees and by reductions in government spending, particularly on Medicare.

The budget office said the bill would reduce future deficits by $132 billion over that period.

Republicans have accused Democrats of using accounting tricks to hide the true cost of the measure, which they predicted would be huge, particularly if Congress did not follow through with the Medicare cuts.

In place of the public option, the Senate bill would create at least two national insurance plans modeled after those offered to federal workers, including members of Congress. The bill includes a new government-run long-term-care insurance program. And it imposes tight new regulations on the health insurance industry, barring insurers from denying coverage based on pre-existing medical conditions and limiting how much extra they can charge based on age.