Senate Democratic leader Harry Reid unveiled an $849 billion bill to reshape the nation's health care system Wednesday night, setting up a historic year-end debate over a measure designed to lower costs and bar insurers from denying coverage because of pre-existing medical conditions.
"Tonight begins the last leg of this journey," said the Nevada Democrat, less than two weeks after the House approved its version of the measure — and nearly 10 months after President Obama's Inauguration Day call to action.
But the measure needs 60 votes to proceed, and after a closed-door meeting of Democrats on Wednesday, it wasn't clear whether all those votes are there yet. Republicans have vowed to maintain a unified force against the measure and slow down consideration as much as possible. Republican Tom Coburn of Oklahoma has threatened to make the clerk read the entire 2,074-page bill before debate can even begin.
The first test is likely to come Saturday on a vote to break a threatened GOP filibuster on the motion to simply get the bill to the floor to formally open debate. If that prevails, full debate is expected to take several weeks.
The Congressional Budget Office estimated that the bill, which merges versions produced earlier by two committees, would cost $849 billion, well under the $900 billion limit Obama had set. The CBO analysis also said the legislation would reduce the federal deficit by $127 billion over the next decade and would continue to save more money later.
Obama said he was pleased that the bill was estimated to save billions while extending coverage to millions of people.
"From day one, our goal has been to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don't, and that lowers costs for families, businesses and governments across the country," he said in a statement. "Majority Leader Reid, Chairmen [Max] Baucus and [Christopher] Dodd, and countless senators have worked tirelessly to craft legislation that meets those principles."
Although the estimated cost of the Senate bill was lower than the House bill's $1.2 trillion price tag, it would cover fewer uninsured Americans. A Senate aide said 31 million uninsured people would be covered under the proposal released Wednesday; the House bill aims to cover 36 million.
The CBO estimated that the Senate's legislation would cover 94 percent of eligible individuals. Under the House bill, about 96 percent would be covered.
The Senate measure would require most Americans to carry health insurance and would provide hundreds of billions of dollars in subsidies to help those at lower incomes afford it. It also would mandate that large companies provide coverage to their workers.
At its core, it would set up new insurance marketplaces — called exchanges — primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government-sold insurance, an attempt to hold down prices charged by private insurers.
One new item in the bill is a half-percent increase in the 1.45 percent Medicare payroll tax for individuals making more than $200,000 a year and couples making more than $250,000. Reid also added a 5 percent excise tax on elective cosmetic surgery. (It's already being dubbed the "botax.")
Lawmakers had struggled to craft a health care bill that fulfills Obama's goal of expanding coverage to uninsured Americans, banning practices that deny coverage on the basis of pre-existing medical conditions, and slowing the growth of health care costs nationwide.
Reid is fighting not only the calendar — Republicans have vowed to prolong debate for at least several weeks, probably pushing a final vote right up to the Christmas holidays — but also his own caucus. He needs the votes of every one of his 58 Democrats, plus independents Joseph Lieberman and Bernard Sanders, to stave off delaying tactics. So far, getting everyone onboard, particularly moderates — including Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas — has been no easy task.
None of the 40 Republicans is expected to defect on the first test vote for the bill, but weeks of maneuvering lie ahead, during which Reid and his supporters will seek to incorporate changes sought by Democrats and to repel Republican attempts to defeat the bill.
The House approved its version of the health care bill on a near party-line vote of 220-215.
Anticipating a major struggle, the White House deputized Interior Secretary Ken Salazar and former Senate Majority Leader Tom Daschle to join Vice President Biden in trying to clear the way for the bill's approval over the next several weeks.
Salazar, a former Colorado senator, is viewed as a bridge to moderate Democrats who are far outnumbered by liberals inside the Democratic caucus.
Daschle was Obama's first choice for secretary of health and human services, a position from which he was to try to oversee the administration's drive to enact health care legislation. He withdrew his nomination when it was disclosed that he had not paid more than $120,000 in federal taxes over several years.
From NPR staff and wire reports.