DAVID ESPO AP Special Correspondent WASHINGTON
Health care legislation backed by President Barack Obama all but cleared a major hurdle in the Senate early Friday as Democratic liberals and moderates on a key committee closed ranks behind the most sweeping set of changes in a half-century. Obama hailed the developments in the Senate Finance Committee as a milestone, and said in a written statement , "we are now closer than ever before to finally passing reform that will offer security to those who have c ove rage and af fo rdabl e insurance to those who don't." The legislation is designed to spread health insurance to millions who now lack it, and cracks down on industry practices such as denying coverage on the basis of pre-existing medical conditions. More than $400 billion in federal subsidies would help defray premium costs for lower- income families and help small businesses offer coverage to their workers. Most policies would be required to cover preventive care as well as treatment for medical illness and vision, dental and mental health needs. It was past 2 a.m. in the East and Obama's top health care adviser, Nancy- Ann DeParle in attendance when Sen. Max Baucus, D-Mont., the committee chairman, announced that work had been completed on all sections of the legislation. "This bill will lower taxes for more than 4 2 mi l l ion Americans and reduce the federal deficit," he said. "This bill will protect Medicare benefits for seniors. This bill will significantly expand health coverage." A final vote was delayed until next week so budget officials can certify the legislation does not add to federal deficits. Given the Democrats' 13-10 majority only the final margin is in doubt. S e n . Ol ymp i a S n owe, R-Maine, said she has not yet decided how to vote. "I've got a lot to think about," she said. All other Republicans on the committee have criticized the bill and are certain to oppose it. The full Senate already is scheduled to begin a historic debate at mid-month on legislation to meet one of Obama's principal campaign promises and a goal of presidents since Harry Truman sat in the White House at mid-20th century. The legislation was built on the wreckage of failed bipartisan negotiations among six members of the committee, and t i l ted at several points to appeal to Democratic moderates more than liberals. Baucus said that was the only strategy that could succeed in gaining 60 votes in the Senate, needed to overcome a threatened Republican filibuster. As a result, it lacks a provision to permit the government to sell insurance in competition with private industry. Instead, it allows non-profit cooperatives to fill that role. Unlike legislation taking shape in the House and a bill that passed a different Senate committee earlier in the year, it does not require businesses to offer insurance to their employees. Instead, companies that do not would be required to offset the cost of any federal subsidies their workers receive when they buy their own insurance in a n ew f e d e ra l l y r e g u l a t e d exchange that would be established. On the other side of the Capitol, Democratic House leaders have struggled in recent days to agree on a bill to send to the floor for a vote later this month. Aides have said the pace of progress could accelerate following the Finance Committee's work. That's because the bill that Baucus steered toward committee approval is viewed as the most middle-of-the-road of all the Democratic alternatives pending in Congress, and House Speaker Nancy Pelosi and her lieutenants are now better able to calculate which elements they can accept and which they may want change in final compromise talks between the two houses. Democrats were in control throughout a two-week debate in the Senate committee, and on the final day of deliberations rejected Republican attempts to strip out tax increases they said violated Obama's campaign promises. They made a number of major changes in the final hours. One would allow a new commission designed to wring savings from Medicare to recommend cuts in federal subsidies paid to low-income seniors who have prescription drug coverage under the program. Other last-minute modifications were designed to build s u p p o r t a m o n g t h e Democratic rank and file and blunt any impact on millions of working class families. One change would exempt millions of people from a requi rement to purchas e insurance that is currently in the bill and reduce the penalties on millions more who defy the mandate. Another would narrow the impact of a proposed tax on high-cost insurance policies. A third would allow the states to negotiate for coverage for individuals and famil ies wi th incomes sl ight ly higher than the cutoff for the Medicaid programs that provides health care for the poor. S e n . Mari a Cantwe l l , D-Wash., said the proposal was based on a system in effect in her home state that has resulted from lower-cost quality care as the state uses its purchasing power to negotiate better prices from insurance companies. "If your governor and your legislators don't want to negotiate on behalf of their citizens, that's their political p r o b l e m , " s h e t o l d Republicans who raised doubts about it and eventually voted against it. In the final moments, Sen. Ron Wyden, D-Oregon, made a n imp a s s i o n e d p l e a t o change the bill to allow workers to leave their employerbacked coverage if they were d i s s a t i s f i e d. "A t y p i c a l American, if they're getting hammered by their employer, they are stuck," he said. His proposal never came to a vote after it became clear it would fail.