Health Care Breakthrough: Ben Nelson Will Vote for Health Reform

Sen. Ben Nelson (D-Neb.) announced Saturday that he will vote for health care reform when it comes up for a cloture vote in the Senate early next week, now that the bill has been changed at his request. As the 60th and final Democrat to signal that he will support the bill, Nelson's decision virtually assures passage of the Democrats' sweeping health care reform.

"I believe this legislation will stand the test of time and will be noted as one of the major reforms of the 21s century," Nelson said in the Capitol Saturday. "Lives will be saved and our health care system will reflect the better nature of our country."

Nelson was the most strident Democratic holdout for the health reform bill going into a snowy weekend session. In an interview with a Nebraska radio station on Thursday, the conservative Democrat voiced his concerns over the bill's abortion funding language and new costs to states from a Medicaid expansion in the bill. Since then, he'd been huddled in intense negotiations with Senate leaders and White House staff eager to secure his vote.

Senate Majority Leader Harry Reid revealed the final package of changes to the bill, known as the managers' amendment, on Saturday morning, which the Congressional Budget Office estimated will cost $871 billion over the next ten years.

The amendment includes portions the previous Senate bill that been rewritten to reflect Nelson's demands for changes to existing abortion funding language, as well as the Medicaid reimbursement rate for Nebraska specifically. Nelson said previously that expanding the Medicaid program to more people would be an unfunded mandate for all states, and would hurt his own state in particular.

The Governor of Nebraska, Dave Heineman, sent a letter to to Nelson this week urging him to vote against the bill, calling it "bad for Nebraska" because of the cost of the Medicaid expansion. The new bill has the federal government permanently paying 100 percent of the cost to expand Medicaid in Nebraska, while other states will pay 2.2 percent of the price to expand the program to millions of uninsured Americans.

Sen. Reid responded Saturday to questions about the new provision for Nebraska. "If you read the bill, you will find a number of states treated differently from other states," Reid said. "That's what legislation is all about. It's called compromise."

Sen. Richard Burr (R-N.C.) took a harsher view of the provision. "You've got to compliment Ben Nelson for playing the Price is Right." Burr said. "He negotiated a Medicaid agreement for Nebraska that puts the federal government on the hook forever. This isn't the Louisiana Purchase, it's the Nebraska windfall...this isn't how this process is supposed to work."

Nelson also said Saturday that his concerns about abortion funding have been satisfied. "I have strongly held views and have fought hard to prevent federal funding for abortions," he said. "I believe we have accomplished that goal." In the managers' amendment, states will be permitted to opt-out of providing abortion coverage on their own state-based health exchanges. An accounting mechanism was also added to segregate federal funds for subsidizing health insurance from private funds for abortion coverage.

The senator warned that his ultimate vote on the bill will not assured until he sees the results of the House-Senate conference committee, where the chambers will combine the two competing versions of the bill. "If there are material changes in that conference report, I reserve the right to vote against the next cloture vote," he said. "I will vote against it if that is the case."

Nelson had intended to make an announcement about his decision from the well of the Senate after votes concluded for the day shortly before 9 a.m., but Republicans used a procedural maneuver to prevent any senators from speaking until the full managers' amendment has been read aloud. Reading the nearly 400-page document will take about eight hours.

Senate Minority Leader Mitch McConnell blasted the latest version of the health reform package as "a legislative train wreck of historic proportions," and specifically criticized the special provisions and "sweetheart deals" for Nebraska and Vermont, the home state of Sen. Bernie Sanders, another threatened holdout for the Democrats in recent days.

"If the Democrats were proud of this bill, they wouldn't be doing it this way. They wouldn't be jamming it through in the middle of the night on the last weekend before Christmas," he said. "The American people have made it abundantly clear that they do not support this bill."

The Senate will cast its first vote on the new Senate health reform bill at 1 a.m. Monday morning.