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Democrats Strike Health Care Deal



Senate Democrats announced a deal Saturday with Sen. Ben Nelson (D-Neb.) to move forward with a health care reform bill, clearing the way for a series of votes on the landmark legislation next week.

“Change is never easy,” Nelson told reporters. “I truly believe this legislation will stand the test of time. The lives of millions Americans will be improved.”

Nelson agreed to support the bill after Democrats strengthened restrictions on federal funding of abortion. In the bill, states can opt out from allowing plans to cover abortion in the insurance exchange. Also, enrollees in plans covering abortion pay separate checks – one for abortion, one for the rest of services.

Nelson also won his own version of Sen. Mary Landrieu’s much-derided “Louisiana Purchase.” In Nelson’s case, the federal government will pick up all the cost of new Medicaid enrollees in Nebraska, rather than share the cost with the state as is usually done. That’s expected to cost the federal government about $45 million over the next decade.

But Nelson also made clear that if the compromise on restricting federal funding of abortion and Medicaid funding don’t survive in the final House-Senate compromise, he will not support the bill.

“If there are material changes in that conference report that are different from this bill, I reserve the right to vote against” the bill, Nelson said. He also said he was assured there would be a “limited” House-Senate conference that wouldn’t make big changes to the bill.

Nelson also said that he didn’t consider it a perfect bill. “I think it’s good enough for us to move forward. I would have dealt with cost containment first and expanding coverage second,” he said, “but you have to take the process in front of you and try to improve it.”

Sen. Chuck Schumer (D-N.Y) told reporters in the Capitol that the deal was finalized late Friday night, with a handshake at 10:30 p.m. The negotiations, which included Senate Majority Leader Harry Reid, Schumer, Nelson and White House officials Pete Rouse and Jim Messina, ended after a marathon 13 hours of talks.

“There were many times they thought they couldn’t come to an agreement,” Schumer said. “We are now for the first time really feeling good. I think every Democrat realized whatever his or her views, we had to get this done.”

But Schumer made clear the negotiations, which centered on abortion funding and Medicaid expansion were touch and go. “There were several times in that room where we thought we wouldn’t have a deal,” he said.

And in fact, Nelson left the Capitol about 10 p.m. Friday telling reporters there wasn’t deal – at least not a final one – and that all sides had to sleep on it.

The compromise gets Reid to the 60 votes he needs to move ahead with health reform, but it’s going to be a long weekend. The first vote right now is set for 1 a.m. Monday – after a reading of the so-called manager’s amendment released this morning. The final vote, under the current calendar, would take place at 7 p.m. on Christmas Eve.

The bill would call for the creation of national health insurance exchange that would allow people to shop for insurance, subsidies to help low-income people buy insurance and an expansion of Medicaid. It does not include the government-run health insurance option that Nelson and other moderates objected to – and its absence has drawn fire from liberal critics who say the bill doesn’t amount to true reform.

One of the biggest hurdles to passing a health reform bill was satisfying Nelson’s demand that restrictions on the federal funding of abortion be tightened. And in the manager’s amendment, Reid threaded the needle on the issue and won Nelson’s support for the bill.

To that end, Reid included a provision that allows states to prohibit abortion coverage in the insurance exchanges the bill creates. It’s basically a state opt-out, which largely allows Democrats to sidestep the tricky issue by pushing it onto the states.

The amendment also requires that health plans that provide abortion services segregate the premiums from any federal subsidies into separate accounts so that federal funds don’t pay for abortion services. Similar proposals have come under fire from pro-life groups who call the maneuver a shell game. They argue that because the insurance plans offered through the exchange are eligible for federal subsidies, taxpayer money is still paying for the coverage of abortion.

While the set up might not satisfy pro-life groups, the important point for Democrats today is that it wins Nelson’s vote, which they need to pass a bill.

Reid needed to get a deal in place so he can begin the procedural steps necessary to pass the health care bill by his self-imposed Christmas Eve deadline. Senate Republicans have already asked for a full reading of the amendment, which could take several hours, depending on its length.

Reid needs the reading to end by 11:59 p.m. Saturday. This is because Reid needs at least one day, which would be Sunday, between when he moves to end the debate on the amendment and when the Senate votes early Monday morning.

Despite the ticking clock for the Democratic leadership, Nelson said Friday he wasn’t operating on a deadline.

“I’m not focused on that deadline. What will be will be when it comes to the deadlines. That’s up the leader to establish,” Nelson said. “I’ve seen a proposed schedule, but I’m not going to predict whether or not we can meet that schedule. I’m focused on getting this right rather than according to a deadline.”

Before Reid can set in motion the steps toward a vote on the bill, the Congressional Budget Office needs to return a cost estimate, which is expected later today.

The lack of details — less than 72 hours before senators are scheduled to cast the first key vote on Monday at 1 a.m. — came under attack Friday from Sen. John McCain (R-Ariz.) and Minority Leader Mitch McConnell (R-Ky.)

“The majority leader has signaled that he is going to unveil the most significant piece of domestic legislation in memory, and his goal after introducing that measure in the morning presumably would be, of course, to vote on it some 36 hours after that,” McConnell said. “What we know for sure at the moment, is that we’ve seen the Pelosi bill and we’ve seen the Reid bill, but none of us … have seen the newest bill, which is a mystery to virtually everyone, including the Democratic leaders of the Senate.”

At a morning press conference, the Republicans used visual aids to press their point. The health care bill from the House and Reid’s original legislation in the Senate were piled on a table — next to a skeleton of packing tape meant to represent the manager’s amendment that had at that point yet to emerge.



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