With the Senate Finance Committee poised to resume the health care debate Tuesday, Florida Sen. Bill Nelson has stepped into the fray — to the relief of some activists.
In recent days, Nelson has proposed a series of amendments to the leading Senate health care reform proposal, prompting hours of debate. One of Nelson's amendments, which would preserve some Medicare coverage critics would like to scale back, could come up for a vote this week, though it faces significant resistance.
Another amendment, to force drug makers to come up with more money for prescriptions for seniors, was defeated in a committee vote last week. Nelson, a member of the finance committee, has suggested he may push for both amendments to be debated on the Senate floor.
The aggressiveness follows criticism from Democratic activists that Nelson spent his summer trying to sidestep the debate. His South Florida office was even the site of a rally aimed at pressuring him to embrace a government-run insurance plan. A spokesman for Nelson said he had waited for committee chairman Sen. Max Baucus to deliver legislation to the committee — the last of five House and Senate panels to take up healthcare reform.
"He's said all along when there was a bill before them that he'd be staking out his positions," Nelson spokesman Dan McLaughlin said. "He wanted to have an actual proposal to address, rather than vague concepts."
Nelson's emergence has been welcomed by activists who back comprehensive health reform — even if his proposals have met with resistance from his own party.
"We're glad to see him weighing in," said Monica Russo, president of the Florida SEIU Healthcare Union. "On huge issues — and this is mammoth — he clearly takes his time to listen. But it seems like he has found his footing."
Yet the centrist Nelson hasn't embraced a public option, or government-run program, as some Democrats have pressured him to do. McLaughlin said the senator has not ruled out a public plan, but said Nelson prefers health care cooperatives in which participants can band together to form nonprofits to provide health care.
Activists — including those who back Nelson — plan to rally outside Nelson's Coral Gables office again next month.
"We need him championing a strong, robust public option," said Dave Patlak, president of the Miami-Dade Democratic Club. "We don't know if we can rely on his vote."
And, Nelson is pressing amendments at odds with fellow Democrats and President Barack Obama, illustrating the challenge the president faces even among members of his own party as he tries to shepherd health care reform through Congress.
Republicans have put Nelson and other centrist Democrats on the committee on notice that they plan to watch their votes in the committee. The GOP attacked Nelson last week for siding with Democrats to reject a Republican amendment that would have required the exact language and full cost of the health care bill be posted online at least 72 hours before a vote.
Nelson's bid to require drug makers to fork over more money to pay for prescriptions for low-income Medicare beneficiaries fizzled in committee last week when three Democrats teamed up with the committee's Republicans to defeat the amendment. They said it would upend a deal struck months ago by the administration, Baucus and the drug lobby to contribute $80 billion in discounts.
McLaughlin said Nelson's proposal — which would have closed a gap in coverage commonly referred to as the "doughnut hole" — had the support of the AARP, which pledged to keep pushing for the amendment.
"When you stand in line at the pharmacy facing nearly $3,000 in out-of-pocket expenses in the so-called Medicare doughnut hole, nobody asks for your political party," McLaughlin said.
Nelson said he may take the provision to the floor for a second chance, along with the other amendment that would prevent cuts to some private Medicare Advantage health programs.
Obama has eyed Medicare Advantage for cost-saving, arguing that the private insurers who provide the coverage and are reimbursed by the government are "overcharging massively" for the same services that Medicare offers. The administration contends that its cuts would not be aimed at seniors' benefits, but at insurance industry subsidies.
Nelson said he's been deluged with calls and letters from seniors worried about Medicare Advantage cuts. In Florida, some 900,000 seniors are covered by such plans, which offer services like vision and dental coverage that traditional Medicare does not.
Nelson's plan would protect seniors enrolled in geographical areas where the Medicare Advantage plans are offered at costs comparable to traditional Medicare plans — namely, higher-cost states like Florida and New York.
"It is the law and many senior citizens have come to rely on that coverage," Nelson said of Medicare Advantage plans during committee debate. "To suddenly whack it away from them, I think is unconscionable."
Critics of Medicare Advantage note many of the seniors riled up about the proposal were prompted by the private insurance companies, chiefly Humana, which sent letters to seniors in a number of states, telling them they could lose their benefits, and urging them to contact their members of Congress. The Centers for Medicare and Medicaid Services said it would investigate whether the letters violated marketing rules. That prompted Republicans to accuse the Democrats of trying to stifle free speech.
Nelson's amendment could come up for a vote in the Senate Finance Committee as early as Tuesday, but Nelson — expecting opposition from at least four Democrats from small states who are on the committee — said he may pull the amendment and save it for the floor.
Among the small-state critics was Sen. Jay Rockefeller, D-W.Va., who called Medicare Advantage "a wasteful, inefficient program" during committee debate last week.
"I recognize there are lots of people in it," Rockefeller said. "But if we are talking about the future and trying to preserve Medicare and services for seniors, you don't tend to want to preserve what doesn't help seniors and doesn't work efficiently."