WASHINGTON — The Senate is ready to begin a volatile, high-stakes health care debate that's sure to be punctuated by tense and unpredictable battles over some of the most incendiary issues in American politics today.
Debate on the $848 billion bill to overhaul the nation's health care system is expected to start next week, after the Senate returns from its Thanksgiving recess, and many lawmakers already consider it a golden opportunity to win long-sought projects and local aid for their constituents.
The flashpoints will be familiar _ abortion, federal deficits, government involvement in health care decisions and other hot topics _ and many Democrats already have said they want to see, and are well-positioned to seek, changes in the bill.
In fact, the legislation is moving ahead only because it got 60 votes Saturday night to proceed _ the minimum needed _ two weeks after the House of Representatives version squeaked through by five votes.
"I, along with others, expect to have legitimate opportunities to influence the health care reform legislation that is voted on by the Senate later this year or early next year," said Sen. Blanche Lincoln, D-Ark., who was Saturday's 60th vote to break a Republican filibuster and start debating the bill.
Sen. Mary Landrieu, D-La., was the 59th vote, and the bill could provide her state with an estimated $300 million in help for health care for the poor.
Sen. Ron Wyden, D-Ore., got the bill altered Friday so more people would have access to its health exchanges, marketplaces where consumers could shop for coverage and rates. Sen. Ben Nelson, D-Neb., was said to be pleased that the bill lacked changes in federal antitrust law protection for the insurance industry.
They all voted yes Saturday, saying they were motivated by a desire to let debate proceed, but many Democrats still had qualms.
"There is a great deal more work that needs to be done," Landrieu said, particularly to help small businesses.
Democrats can expect little help from Republicans, who stuck together Saturday to oppose proceeding and vowed that Democrats would pay a political price if the bill remained largely intact.
"This 20-pound bill is the size of most people's turkeys next week," said Sen. Richard Burr, R-N.C., "and that's what most people in North Carolina think of this bill."
The measure would require most people to obtain insurance coverage. It would set up health insurance exchanges and offer them the alternative of a government-run program, or public option. In most cases, people would pay fines if they didnt get coverage.
At least four areas are likely to be major flashpoints:
- Abortion. At least four Democratic senators are considered staunch abortion foes, and they're likely to be uncomfortable with the Senate bill's provisions that allow abortion coverage in federally subsidized plans, as long as only private funds are used to pay for such coverage. The House legislation is more restrictive.
- Public option. The plan in the Senate bill, which would allow states to opt out, makes a lot of Democrats nervous; at the moment, it lacks the 60 votes needed to overcome procedural hurdles.
"Who pays if it fails to live up to expectations?" asked Lincoln.
- Budget deficits. The nonpartisan Congressional Budget Office estimates that the bill would cut $130 billion from the deficit over 10 years, but many experts and legislators are skeptical that it can achieve that without cuts in Medicare and other programs that politicians are unlikely to make.
- Affordability. "Many Americans will be required to purchase health insurance that is more expensive . . . than the coverage they currently have," said Sen. Susan Collins, R-Maine, a GOP moderate.
The CBO did find that people enrolling in the public option "would typically have premiums that were somewhat higher than the average premiums for the private plans" people could buy through the new exchanges.
Despite all these controversies, Democratic leaders said that near-universal coverage legislation, a goal of party leaders since the 1940s, has now proceeded farther than ever before.
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