Senators Begin Historic Health Care Debate Amid Teetering Public Support

After months of preparation and committee-level work, the full Senate began debating its version of health care reform Monday afternoon. The bill, introduced by Senate Majority Leader Harry Reid (D-Nev.), would expand health coverage to an estimated 30 million Americans by reforming insurance practices and creating an insurance exchange where consumers could purchase coverage, including insurance provided through a government-run public agency. If the cost of coverage is too expensive for an individual or family, the government would subsidize the premiums and pay for them with a series of tax increases.

"This is a good bill. It saves lives, saves money and saves Medicare," Reid said as he began the process on the Senate floor. Reid defended his bill, which he negotiated privately with White House staff, and blasted Republicans for suggesting that the Senate should scrap the entire bill and re-start the process, as Republican Leader Mitch McConnell of Kentucky suggested over the weekend.

"That is exactly what the legislative process is about," Reid said. "Debating, amending and improving. Democrats stand ready to do so, and I hope my Republican colleagues recognize that reality – even if their party's leaders deny it."

No sooner had Reid urged Republican cooperation than Sen. Mike Enzi (R-Wyo.), the top Republican on the Senate Health Committee, objected to the first two Democratic additions to the bill. Enzi said he thought both ideas were good, but he had not seen the two amendments before Reid introduced them without notice.

"I had high hopes that this would be the year that the Democrats and the Republicans of the Senate would work together to provide health insurance to every American," Enzi said. "The bill being debated today is a testament to a partisan, ideological vision." He called the legislation a "deeply flawed bill" that will raise the cost of health care instead of lowering it.

Sen. Charles Grassley, the top Republican on the Senate Finance Committee, accused Democrats of using budget gimmicks to make the bill appear deficit-neutral, when it is not. Grassley's complaint stems from the fact that the tax increases in the bill would begin immediately, while the most expensive provisions -- such as creating the government option -- would not phase in until 2014. "It will make a bad situation worse," Grassley said of the bill's effect on the federal deficit. (It takes 10 years of taxes to pay for six years of benefits.)

Regardless of Republicans' fervent objections to the bill, Reid's greatest challenge will come from his fellow Democrats, since he'll need the votes of all 58 Democrats, as well as independents Sen. Bernie Sanders of Vermont and Sen. Joe Lieberman of Connecticut, to clear several procedural hurdles that require a 60-vote majority. Several key elements of the bill, including support for the public option, are short of the 60 votes needed for final passage. Both Sens. Blanche Lincoln of Arkansas and Joe Lieberman have said they will vote against any bill with any version of a public option in it, while Sanders said it would be "very, very hard" to vote for a bill without it.

Other contentious issues will be: the cost of the bill, which moderate Democrats want to keep under $900 billion over 10 years; the excise taxes on high-end insurance plans, which union leaders staunchly oppose; the question of how abortion services will be treated in the exchange; and whether illegal immigrants can access insurance even if they use their own money.

Hours before the Senate began its debate, the Congressional Budget Office released a report showing that the Senate bill would increase health insurance premiums in the individual market by an average of 10 percent. However, the government's plans to subsidize monthly insurance premiums for millions of Americans -- about 60 percent of the individual purchasers -- would mean they would not feel the increased costs directly, and would have lower costs for better care. The costs would be absorbed by taxpayers and companies on the receiving end of tax increases, including a Medicare payroll tax hike on income over $200,000, a 40 percent excise tax on high-end insurance packages, and new taxes on medical devices and prescription drugs.

As the Senate debate began in Washington, polls showed support for the measure and for President's Obama's leadership on health care both below 50 percent. As Bruce Drake wrote earlier, a new USA Today/ Gallup poll shows 49 percent of Americans would urge their representatives to vote against the health care bill, while 44 percent want their member of Congress to vote for it. The poll also found that Americans disapprove of the way President Obama has handled health care policy by 53 percent to 40 percent.

But Reid stressed that the bill the Senate is starting with is not the bill it will end with, and that rather than dismiss the effort out of hand, senators should work to make the legislation something they can support for their constituents.

"While each of us may not say 'yes' to each word in this bill as it currently reads, let us at least admit that simply saying 'no' is not enough," he said. Reid also prepared his fellow senators to work overtime on the effort, telling them he'll schedule votes on nights and weekends throughout December to get the bill done. "We will do this work transparently, and we will do this work tirelessly."