Senate set to vote on landmark health care bill [BC-SENATE-HEALTHCARE:TB]

WASHINGTON _ The Senate was poised Sunday night to take a giant step closer to enacting its sweeping health care bill _ a watershed moment that united fractious Democrats after months of debate over President Obama's promise to provide universal health care coverage.

The move to break a Republican filibuster, which required winning the votes of all 60 members of the Democratic caucus, capped months of work by Obama and Senate Majority Leader Harry Reid, D-Nev., who personally forged the necessary compromises on big issues such as abortion and taxes, as well as parochial deals for favored states and industries.

But with final Senate approval of the bill expected later this week, Democrats and the White House were moving to shift the focus away from the dozens of concessions made in writing the bill and toward the momentous changes it would bring: Bestowing access to insurance on 31 million Americans, cracking down on mercurial insurance practices and beginning to curb unsustainable medical inflation

"I wish this bill were different," said Assistant Majority Leader Richard J. Durbin, D-Ill., said on the Senate floor Sunday, reflecting liberals' unhappiness over some of the compromises with conservative members of their own party.

"But my disappointment...shouldn't lead me to conclude that this bill is wanting or this bill is bad. Just the opposite is true ... We have to look at the positive side of what this legislation will do."

The bill's progress provides a needed shot of adrenaline for Obama and the Senate as opinion polls indicate the public's support for the health care overhaul is waning substantially. Hoping to reverse that slide, Democrats and the White House are ramping up their efforts to reshape public perception of the bill as a glass half full, not half empty.

"This is a historic crossroads," David Axelrod, senior Obama advisor, said Sunday on NBC's "Meet the Press." "Seven presidents have tried to pass comprehensive health insurance reform, seven presidents have failed. We're on the doorstep of getting it done."

Shifting the focus on how much change the bill would deliver _ rather than the political sausage-making that preceded it _ will be particularly important as senior lawmakers in the House and Senate begin another arduous round of compromising and deal-making to reconcile substantial differences between the health care bills developed in the two chambers.

The Senate's dramatic first vote to shut down the Republican filibuster capped a weekend session that marked the third time in the last month the Senate has met on Saturday and Sunday. Two more procedural votes to close debate _ on Tuesday and Wednesday _ will be taken before the bill comes to a final vote.

Republicans conceded they were essentially powerless to derail the bill. But they vowed to force the debate to continue as long as possible _ probably until Christmas Eve.

"We will fight until the last vote," Sen. John McCain, R-Ariz., said on "Fox News Sunday." "We must do everything. We must look back and say, 'We did everything we can to prevent this terrible mistake from taking place.' "

In the death knell for Obama's hope the bill would receive even token bipartisan support, Sen. Olympia Snowe, R-Maine, the one Republican who even considered supporting the bill, Sunday formally announced she opposed it.

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"I deeply regret that I cannot support the pending Senate legislation as it currently stands, given my continued concerns with the measure and an artificial and arbitrary deadline of completing the bill before Christmas that is shortchanging the process on this monumental and transgenerational effort," she said.

Her Maine colleague, Republican Susan Collins, also announced her opposition Sunday.

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Other Republicans turned a spotlight on the special deals that were cut to win the support of Sen. Ben Nelson, D-Neb. _ who provided the last vote Reid needed after winning special treatment for his state's Medicaid program, changes sought by insurance companies in Nebraska, as well as tighter restrictions on federal funding for abortion.

That kind of horse-trading is common practice in Congress, but Republicans said it was unseemly in a bill of such far-reaching implications.

"This process is not legislation," declared Sen. Tom Coburn, R-Okla. "This process is corruption."

But Democrats emphasized the broader provisions of the bill that provide concrete direct benefits to consumers _ including major changes that have been eclipsed in the final stages of the debate.

Among them, the Senate bill includes a "patient bill of rights"_ a package of consumer protections that, when they were considered on their own more than a decade ago, died amid heated controversy. The bill also would establish a new requirement designed to ensure insurance companies use more of their premium income for patient services, not profits or administrative costs.

That was an important consolation prize for liberals who sought a government insurance program in large part as a way to provide competition for private insurers.

"Now they must be accountable to consumers and spend more of their hard-earned dollars on actual health care and not on filling their coffers," said Sen. Jay Rockefeller, D-W.Va., who has led investigations of the health insurance industry.

Democrats hope the more the public knows about those and other benefits and consumer-oriented provisions of the bill, the more they will like it.

They have their work cut out for them. Public confidence in Democrats' health care initiative has been sagging for months.

Today, just 45 percent of Americans believe the country will be better off with "reform," down from 59 percent in February, according to a tracking poll by the nonprofit Kaiser Family Foundation, which surveys public opinion about health care. And just one in three Americans believe "health care reform" will leave them and their families better off, according to, the lowest measure all year.

"People believe they will be paying more taxes," said Robert Blendon, an expert on public opinion at the Harvard School Public Health. "They are afraid about what is going to happen to Medicare. ... They have just gotten very nervous."

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That is happening just as Democrats face what will likely another grueling round of debate on the issue early next year.

As a House-Senate conference committee begins trying to reconcile differences between the differing versions of the bill, Democrats will once again debate whether the final bill should include a new government insurance program, as the House legislation currently does.

They will have to forge new compromises over how to pay for the legislation. The House bill relies heavily on a new surtax on high-income taxpayers, while the spending in Senate bill is offset by a new tax on high end, so-called "Cadillac" health plans.

The emotional abortion issue _ which stalled both House and Senate bills in their final stages _ will have to be revisited because the two measures restrict federal funding in different ways.

They contain different formulas for expanding the joint state-federal Medicaid insurance program for the poor and different mandates for employers to provide their workers with health benefits.

Lawmakers will have to contend with competing provisions for ensuring undocumented immigrants can't buy health insurance. And they will have to iron out many smaller differences in the way the two bills regulate insurance companies.

The negotiations could stretch for weeks or months, but Senate Democrats warned any major divergence from their bill could demolish their fragile consensus and torpedo the bill.

"Anybody who's watched this process can see how challenging it has been to get 60 votes," said Sen. Kent Conrad, D-N.D., on "Fox News Sunday."

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(c) 2009, Tribune Co.

Distributed by McClatchy-Tribune Information Services.

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