Senate readies for key healthcare vote

Reporting from Washington — 

After negotiating critical last-minute commitments, Senate Democratic leaders on Friday stood on the verge of achieving the necessary 60 votes to begin debate on the most expansive healthcare legislation to go before the Senate in nearly half a century.

Nebraska Sen. Ben Nelson, who had been among three Democratic holdouts, announced that he would back an all-important procedural vote set for today that would allow the chamber to take up the wide-ranging bill unveiled this week by Senate Majority Leader Harry Reid (D-Nev.).

Democratic leaders also expect Sens. Blanche Lincoln (D-Ark.) and Mary L. Landrieu (D-La.) to support a cloture vote on the so-called motion to proceed, although the two lawmakers have not formally announced their plans.

With the backing of those three senators, Democratic leaders would be all but assured of clearing the procedural hurdle, a key step if Congress is to send President Obama a healthcare bill by the end of January, as party leaders hope.

Republican lawmakers have kept up a steady effort to make it more difficult for conservative Democrats to vote to open debate, casting the parliamentary move as a referendum on the healthcare bill itself.

This “vote is something we need to look at as a vote that’s not some sort of . . . a procedural vote,” Sen. Judd Gregg (R-N.H.) said on the Senate floor Friday. “It’s a substantive vote on whether or not we’re going to fundamentally change the way healthcare is delivered in this country.”

But Nelson firmly rejected that characterization.

“It is only to begin debate and an opportunity to make improvements,” he said in a statement Friday. “If you don’t like a bill, why block your own opportunity to amend it? . . . I won’t slam the doors of the Senate in the face of Nebraskans now. They want the healthcare system fixed. The Senate owes them a full and open debate to try to do so.”

Nelson has indicated unease about several key components of the legislation, including the creation of a new government insurance plan and restrictions on federal funding for abortion, which Nelson said he wants to see strengthened.

The Senate is expected to start formal debate on Democrats’ top domestic priority when lawmakers come back from their Thanksgiving recess on Nov. 30 -- beginning with consideration of a series of proposed amendments from both sides of the aisle.

The House has already passed its version of healthcare legislation, which will ultimately have to be reconciled with the Senate bill.

The Senate measure, which would cost an estimated $848 billion over 10 years, is designed to eventually expand coverage to an additional 31 million Americans, while restraining federal deficits and taking steps to make the nation’s healthcare system more efficient and reliable for patients.

It is funded by a politically delicate mix of cuts to the federal Medicare system and new taxes on healthcare industries, high-end “Cadillac” health plans and wealthy households.

The measure is so politically charged that finding the votes even to take up debate on the legislation turned into a Capitol drama that dragged on for weeks.

With Republican lawmakers determined to filibuster every stage of the legislative process, all of the 58 Democratic senators and the two independents who caucus with them must hold together to move any healthcare legislation.

That has forced the majority leader, a veteran parliamentary strategist, to cut numerous side deals to satisfy the demands of individual lawmakers in his caucus.

Reid included language in his bill that would boost aid for Louisiana’s Medicaid insurance program for the poor in a bid for Landrieu’s support.

He slashed proposed new taxes on the medical device industry to ease the concerns of Democrats from states that are home to large device makers, such as Indiana’s Sen. Evan Bayh.

And on Friday, Reid struck a deal with Oregon Sen. Ron Wyden, who has been pressing to allow more Americans to use new insurance exchanges in which commercial insurers would compete to offer plans to consumers who do not get health benefits through work.

Wyden’s proposal, which Reid agreed to add to the bill, would open the exchanges to about a million workers who could not afford the health plans offered by their employers, according to an estimate from the nonpartisan Congressional Budget Office.

The delicacy of the negotiations was underscored early Friday by a partisan squabble over whether Lincoln had already made a backroom deal with Reid for her vote.

Assistant Majority Leader Richard J. Durbin (D-Ill.) had earlier suggested to reporters that Lincoln had committed her vote to Reid.

Republicans seized on the comment as a sign that Lincoln, who is up for reelection next year, had given in to the party machine. Durbin was forced to quickly backtrack to preserve Lincoln’s independence.

“Let me be clear,” Durbin said in a statement later in the morning. “Sen. Lincoln has had a number of conversations with Sen. Reid about the healthcare reform legislation. She has asked important questions and there has been a positive and healthy give-and-take. But Sen. Lincoln has not yet signaled her intention as to how she will vote.”

These early exchanges indicate that Reid’s attempt to pass the healthcare legislation, even if he prevails on the procedural motion today, will not be easy.

Senate rules will require Reid to cobble together 60 votes again to end debate on the healthcare bill and bring it up for a final vote, which he hopes to do before Christmas.

Several lawmakers who oppose the government insurance plan, including Sen. Joe Lieberman (I-Conn.), said they would not vote for a bill unless the “public option” provision is removed.

They may back an amendment during the upcoming debate that would create a so-called trigger. Under such an arrangement, a government plan would be created only in parts of the country where commercial insurers did not meet benchmarks for quality and affordability.

Liberal lawmakers, meanwhile, plan to seek other changes, including more aid to low-income Americans to help them buy health insurance.

Vermont Sen. Bernie Sanders, an independent who caucuses with Democrats, said that although he would support today’s procedural vote, his support for a final bill was “not at all guaranteed.”

noam.levey@latimes.com