Health Care Overhaul Advances, But Not Without A Fight

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JENNIFER LUDDEN, host:

I'm Jennifer Ludden, and this is TELL ME MORE from NPR News. Michel Martin is away this week.

Coming up, two medical panels last week recommended less cancer screening for American women. That's sparked confusion and a political uproar. We'll speak with a women's advocate about the implications.

But first, the Senate voted this weekend to open official debate of the health care overhaul plan. In a rare Saturday session, the Senate voted 60 to 39, right along party lines. The plan now faces weeks of debate and dozens of amendments that could change it substantially.

NPR's congressional correspondent David Welna covered the Saturday vote, and he joins us now. Hi, David.

DAVID WELNA: Hi, Jennifer.

LUDDEN: So the Senate needed 60 votes to start this debate, and apparently getting them was a real nail biting experience for Senate Leader Harry Reid. Can you recap for us what happened to persuade the late deciders?

WELNA: Well, there were really three members of the Senate Democratic Caucus who held out until the very final hours before the vote. Senator Ben Nelson of Nebraska announced his intention to support this procedural motion to bring the bill to the floor on Friday and that increased pressure on the other two hold outs, Louisiana's Mary Landrieu and Arkansas' Blanche Lincoln. Both of them announced hours before the vote on Saturday that they too would be voting with the Democrats and that got them exactly to 60 votes, the absolute minimum number to head off a Republican filibuster of this bill, which would have basically bottled up the bill and kept it from being considered on the floor.

LUDDEN: And it was just some trade off there? What did they get?

WELNA: Well, of course, there was some trade off. Senator Reid, in fact, spoke with virtually every member of his caucus to find out what their concerns and what their needs were. We know that Mary Landrieu of Louisiana was given assurances in the legislation itself that there would be a special fund for states hit by big disasters�

LUDDEN: Hmm. Let's see.

WELNA: �for Medicaid bills. And that, of course, seem to single out one state Louisiana because of Katrina and that there was at least $100 million to help defray additional Medicaid costs in the future from this legislation, and that's being called the Louisiana Purchase because in fact she swung over and joined the Democrats after that happened.

LUDDEN: Now, it was a party line vote, but there is lots of dissensions clearly among Democrats themselves. One of the most contentious issues, the so-called public option, under which the federal government would offer a public health insurance plan. What is the likelihood that this being approved as it is now in the final version of a Senate bill?

WELNA: Well, it's not clear. This is an opt-out plan. That is states that don't want to participate are able to opt out of it, but it is a national plan. And some senators such as Nebraska's Ben Nelson are saying that if that plan stays as it is in the bill, they will join a Republican filibuster to keep the bill from coming to a final vote. That would really derail it. So, there's an expectation that there will be attempts to modify the bill. Nelson says that he'd be happy to have an opt-in plan where states could choose to be in a public option, but it wouldn't be assumed that all of them would.

Others such as independent Connecticut Joe Lieberman are saying simply that if there's any public option in the plan, they too will filibuster this. So there will be a lot of horse trading going on the floor. There's an idea that there might be a trigger that would enact a public option only if private insurance companies were not offering affordable rates.

This is something that Maine Republican Senator Olympia Snowe, the only Republican in the Senate to have voted for any other committee health care plans, backs and it's something that is seeming to pick up certain amount of speed. At the same time, you have liberal Democrats saying if you change this public option and water down any further, we're not going to back the bill. So there's a quite a quandary for Majority Leader Reid.

LUDDEN: So, David, what happens next?

WELNA: Well, the bill is now officially going to be taken up and amended on the floor. Both sides are going to be able to offer amendments. The thing is that because Democrats have 60 members in their caucus, they are going to probably be able to stop most of the Republican offered amendments. Republicans feel that they don't have the votes really to alter this bill.

One issue that they feel they can pick up Democrats on is abortion. The language in the Senate bill is somewhat less restrictive than the House bill on the rules governing which companies could offer a coverage that includes abortion and which couldn't. And there are going to be efforts to make that language much more restrictive, but even the proponents of that fear that they don't have the 60 votes to change that. So, I think we're going to hear a lot of rhetoric from the Republicans on the floor, but probably not a lot of Republican amendments going through.

LUDDEN: David Welna is NPR's congressional correspondent. Thank you so much, David.

WELNA: You're welcome, Jennifer.

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