WASHINGTON — Senate Democratic leaders Wednesday unveiled a sweeping $849 billion plan to overhaul the nation's health care system, a proposal likely to trigger an epic Senate battle over how consumers will buy and maintain coverage.
The Senate could vote as early as Saturday to begin debate on the measure, which the nonpartisan Congressional Budget Office estimates should shave $127 billion from the federal deficit over the next 10 years, the biggest projected savings of any major health care bill thus far.
The legislation would require most people to obtain insurance and create a government-run insurance plan, or public option, starting in 2014, in states could choose to not participate.
It would bar insurers from denying coverage because of pre-existing conditions and set up exchanges, or marketplaces, where consumers could easily compare coverage and rates, and provide federal help for lower-income people to obtain policies.
Getting the 2,074-page bill approved promises to be a lengthy, arduous struggle, but an unusually optimistic Senate Majority Leader Harry Reid, D-Nev., said that "tonight begins the last leg of this journey we've been on for some time . . . the finish line is finally in sight."
Sixty votes are needed to begin debate on the measure, and Senate leaders said they're confident they'll get the votes to proceed after talking with three wavering moderates, Arkansas' Blanche Lincoln, Louisiana's Mary Landrieu and Nebraska's Ben Nelson.
Nelson said that while he remained undecided, the possible Saturday vote shouldn't be seen as a judgment on the bill's substance. "It is a motion to start debate on a bill and to try to improve it," he said.
Other moderates were also cautious. "We'll wait and see," Lincoln said. Added Sen. Evan Bayh, D-Ind., "I'm going to reserve judgment until I've had a chance to read it, but the numbers on deficit reduction are encouraging."
Republicans, who've bitterly opposed similar initiatives, vowed to fight; Senate Minority Leader Mitch McConnell of Kentucky called it a "yet another trillion dollar experiment," and vowed "this will not be a short debate." He could find some allies among moderate Democrats.
Liberals were ecstatic, though. The cost estimate was within President Barack Obama's goal of $900 billion, and the bill would lower the number of uninsured by 31 million.
"What's not to like about this bill?" asked Senate Health Committee Chairman Tom Harkin, D-Iowa.
The long-awaited bill differs from the version passed in the House of Representatives Nov. 7 in at least three crucial ways.
First, its government plan would permit states to "opt out," whereas the House doesn't, though the CBO preliminary analysis still figures 94 percent of eligible Americans would be covered, compared with the current 83 percent. The House bill would result in coverage for an estimated 96 percent.
Second, the Senate measure would raise funds with a variety of taxes, notably a tax on more expensive insurance policies — $8,500 on policies for singles and $23,000 for families — and a 0.5 percentage point boost, to 1.95 percent, in the Medicare payroll tax for singles with adjusted gross incomes above $200,000, and families earning more than $250,000.
Congress' Joint Committee on Taxation estimated that the high-end insurance tax would raise $149.1 billion over 10 years, while the Medicare tax increase would raise $53.8 billion.
Neither provision is in the House bill, which would instead impose an income tax surcharge on the wealthy.
Third, the Senate bill has less restrictive language than the House on abortion, which is sure to spark a fight.
If the Senate moves ahead with consideration of the bill, the debate is expected to last until lawmakers leave for a holiday recess in late December and perhaps continue into January.
If the Senate passes a bill, it would have to be reconciled with the House version. A negotiating committee of both chambers' leaders would craft the compromise, and both chambers would then have to approve it sometime early next year.
The Senate debate is expected to include efforts to change almost every aspect of the massive bill. As Sen. Christopher Dodd, D-Conn., a key architect of the legislation, said Wednesday, "this is a dynamic process."
The public option, for instance, is expected to be tested in several ways. Some senators are likely to seek a vote on a public option similar to the one approved by the House.
Sen. Kent Conrad, D-N.D., has pushed "co-ops," or non-profit, member-run insurance groups that would provide coverage, and Sen. Tom Carper, D-Del., is floating the idea of having the government set up a private, nonprofit firm that would make insurance available in states that did not have what Washington saw as affordable coverage.
"I don't think we've even been given all the options people might consider," Dodd said.
Another key test of the bill's strength is likely to involve abortion. Anti-abortion Democrats nearly derailed the House bill earlier this month, until they got a last minute concession that bars federal money from paying for abortions except in the cases of rape or incest or where a woman's life is in danger.
Anti-abortion senators from both parties have vowed to oppose the bill unless the restrictions are included. Sen. Orrin Hatch, R-Utah, said Wednesday he expects to propose language similar to that adopted in the House.
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