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Senate Closes In on Health Care Deal

Senate Democrats on Tuesday moved to close ranks on health care and put nearly a week of infighting behind them, as President Barack Obama and Democratic leaders worried that continued divisions might kill their chance to pass landmark reform legislation.

One day after Senate Majority Leader Harry Reid (D-Nev.) dropped proposals to expand Medicare and implement a public insurance option from the health care package, most liberal Democrats supportive of those measures said they would still vote for the bill. Democrats stressed that the legislation included long-sought-after insurance reforms and said passing something this year would facilitate additions and improvements to the package in the future.

But even though Sen. Joe Lieberman (ID-Conn.) — the highest-profile holdout in the Democratic Conference — signaled that the scaled-back package would earn his vote, intraparty differences persisted and a 60-vote coalition remained elusive. Moderate Sen. Ben Nelson (Neb.) was still looking for a resolution to the abortion issue, and several liberal Senators wanted to review the final product before accepting a package without the public insurance option.

Following a Tuesday afternoon White House meeting with Obama, however, Democrats indicated that they were close to resolving their disagreements and headed toward a cloture process that would enable them to overcome an expected Republican filibuster attempt and meet Reid’s goal of clearing a bill by Christmas. “Pass this— was how Sen. Debbie Stabenow (Mich.) summarized Obama’s message to the majority.

“We’re down to days now,— Sen. Bob Casey (Pa.) said following the meeting with Obama when asked how close his Conference was to uniting on health care reform. “We’re not down to two weeks or three weeks. We’re down to days.—

Before completing his revised health care package and submitting it to the Conference for review and sign-off, Reid needs Congressional Budget Office cost estimates on a basket of proposals developed as an alternative to the public option that is part of the current bill. At press time, Reid had not received the CBO scores.

[IMGCAP(1)]When the CBO delivers, combined with how fast all 60 members of the Democratic Conference can agree to an altered bill, could determine whether the package is approved before Dec. 25. According to an internal memo generated by Majority Whip Dick Durbin’s (Ill.) office, the cloture process requires a minimum of six days (unless Republicans agree to shorten the process), suggesting Reid needs to move to end the debate on Friday in order to complete the process before Christmas Eve.

Sen. Mark Pryor (Ark.), who helped broker the tentative public option compromise, said he believes the bulk of the deal will hold, but he emphasized that the CBO score will determine when the Senate votes. Two provisions of that agreement — an expansion of Medicaid and allowing individuals ages 55 to 64 to buy into Medicare — are now off the table at the behest of Democratic centrists.

“Overall, my sense is that the Democrats will support this and we’ll just have to wait and see,— Pryor said, adding that Senators should know in the next day or two whether they have the votes to pass the bill by Christmas.

As opinion polls over the past 10 days showed increasing public dissatisfaction with the Democrats’ health care agenda and as the Democratic infighting escalated, Reid — with the tacit support of Obama — acted on Monday to salvage his bid to pass heath care this year.

Facing a firm filibuster threat from Lieberman if the final bill contained a public option or Medicare expansion, and with other Democrats increasingly on the fence because of those and other issues, Reid — in consultation with his Conference — eliminated them from the bill. Democratic liberals reluctantly approved, realizing that the clock was working against them and that there was a possibility the bill could die altogether.

“The longer this bill is out there, the harder it is to pass. The Republicans know this, which is why they’re trying to stall. They know time is on their side,— a senior Democratic Senate aide said. “There are many reasons we should get this done by the end of the year. We have some big challenges in this country, first and foremost the economy.—

With the public option and Medicare buy-in now appearing to be out, Lieberman privately assured Obama and fellow Democrats on Tuesday that he would likely support the chamber’s health care reform bill if it comes to a vote later this month. But the Senator said he would withhold judgment until he sees the actual legislative language and an official cost estimate of the new proposal.

Other centrist Democrats said they would do the same.

“If, as appears to be happening, the so-called public option government-run insurance program is out and the Medicare buy-in — which I thought would jeopardize Medicare, cost taxpayers billions of dollars over the long haul, increase our deficit — is out, and there are no other attempts to bring things like that in, then … I’m getting to that position where I can say what I’ve wanted to say all along, that I’m ready to vote for health care reform,— Lieberman told reporters in comments aired on MSNBC.

Democrats have faced additional intraparty divisions, on issues including abortion and the re-importation of prescription drugs. A vote was set to be held Tuesday evening on competing Democratic amendments related to the drug re-importation issue — one offered by Sen. Byron Dorgan (N.D.) and the other proposed by Sen. Frank Lautenberg (N.J.).

Meanwhile, Nelson, who has vowed to filibuster if the bill does not include a strong prohibition against the use of federal funds to pay for abortions, is working with Casey to develop compromise language acceptable to pro-abortion-rights Democrats. Nelson and Casey said Tuesday that progress is being made on that front. An amendment offered by Nelson that he and Casey supported was defeated last week.

“Sen. Reid and I spoke [Tuesday], and I think he feels he’s making progress,— Nelson said.

With Republicans unanimous in their opposition to the Democratic health care bill, Democrats have been forced to pursue a strategy of finding all 60 votes within their own ranks.

Among those in the GOP Conference, moderate Maine Sens. Susan Collins and Olympia Snowe remain the most open to voting for the Democratic package. But Snowe, who voted for the Finance Committee health care bill, continues to find the measure currently under consideration on the floor objectionable. Collins is even more opposed than her home-state colleague.

On Tuesday, Collins said the omission of a public insurance option and the Medicare expansion would not be enough to allay her concerns about the bill, noting she has problems with the nearly $450 billion in Medicare cuts.

“I don’t see voting for the current bill that is on the floor even with the improvements that have been made,— Collins told reporters. “It is still too deeply flawed for me to support it.—

Snowe did not go so far as to announce her opposition, but she said she has told Reid and Obama that their push to pass the bill by Christmas may not give her enough time to fully vet the bill. She acknowledged that the president and Reid have attempted to assuage her concerns about the timeline by saying any remaining issues she may have with the bill could be dealt with during a forthcoming House-Senate conference.

“We still don’t have the final version as scored by CBO, and we’re expected to start voting on cloture somewhere toward the end of this week,— Snowe said, adding: “I’m not going to get into what my votes are or not. I’m just working through this process. I’m just laying out my deep concerns.—

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