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Snow shutters D.C., Senate has 60 votes

by Mark Silva

It's snowing so hard on Washington today that they are grounding all buses and surface trains. It's not going to stop anytime soon.

There's already a foot of snow on the ground, and it's falling so thick that the path is covered with a half-inch of snow before the shovel reaches the end of the walk.

This may sound like no big deal in climes such as Chicago or other Northern realms -- and in Nebraska, a state that has a certain relevance in Washington today -- but it hardly ever snows like this in the nation's capital.

It's lovely, the silence.

Yet this hasn't stopped the Senate's Democratic leaders from pressing for passage of a health-care bill before Christmas.

And the word today is that Sen. Ben Nelson, the Nebraska Democrat who has represented one of the toughest-to-get votes for a bill, has agreed to sign on.

The Senate has 60.

President Barack Obama, who has been "optimistically cautious'' about getting a Senate vote before Christmas, is home from Copenhagen and bound for Hawaii with his family soon for a Christmas vacation.

See the wire report on the Senate situation below:

We're going out with our grandchild to play in the snow.

(Sen. Ben Nelson (D-Neb.) is pictured outside the Capitol today following his agreement to support the health care legislation that fellow Democrats are pushing in the Senate. ( Photo by Harry Hamburg) The West Wing of the White House is pictured by Mandel Ngan / AFP / Getty Images.

By Laura Litvan and Kristin Jensen

Dec. 19 (Bloomberg News)The U.S. Senate is poised to pass the most sweeping overhaul of the nation's health-care system in four decades after Senator Ben Nelson of Nebraska decided to join his fellow Democrats in supporting the measure.

"The lives of millions of Americans will be improved," Nelson said of the legislation during a news conference today. "Lives will be saved and our health-care system will once again reflect the better nature of our country."

A final vote may still be days away as Republicans employ every procedural tactic they have to delay. Senate leaders had described Nelson as the chief holdout among Democrats, who control the chamber, and Nelson told reporters he believes the rest of his party is ready to back the legislation.

Nelson struck a deal last night with Senate Majority Leader Harry Reid that satisfied his demand to keep federal subsidies from being used for abortion. That was the last sticking point after Reid worked to make last-minute changes to win over Nelson and a range of other Democrats.

Reid's plan would cover 31 million uninsured people and reduce the federal deficit by $130 billion over its first decade, a Democratic aide said. The plan, now being read on the Senate floor, would cut the deficit by about $650 billion during the second decade, the aide said.

House Bill

Like the $1 trillion measure passed Nov. 7 by the House, the Senate plan would require Americans to get health coverage or pay a penalty. It would expand the Medicaid health program for the poor, set up online insurance-purchasing exchanges and provide subsidies for those who need help buying policies.

To pay for the expansion of health insurance, the Senate bill relies on hundreds of billions of dollars in savings from the Medicare program on the elderly. It also contains a new tax on high-end insurance plans.

Reid needed Nelson's support for Democrats' top domestic priority because they have no backing from Republicans. Passage of the bill will require all 60 votes controlled by Democrats to cut off stalling tactics from Republicans who say the measure would raise taxes, hurt insurers and widen the federal deficit.

New York Senator Chuck Schumer said a final Senate vote on the measure could take place by Dec. 24 even if Republicans exhaust all their procedural rights to delay it. It then would have to be reconciled with a version passed by the U.S. House and signed by President Barack Obama.

'Shoulder to Shoulder'

"All Senate Democrats stand shoulder to shoulder with President Obama," Reid said during a news conference at the Capitol today.

Nelson warned that his vote isn't guaranteed if the bill changes much in negotiations with the House.

He said his support is based on an understanding "that there will be a limited conference between the Senate and the House." If there are big changes that affect the agreement he's reached, "I will vote against it," Nelson said.

The legislation would set up an elaborate accounting procedure to prevent the use of any government funds to finance abortions covered by private insurance sold on the new online exchanges. It would segregate premiums paid by the beneficiary from any federal tax credits, cost-sharing reductions, or premium subsidies given to low-income consumers.

Nelson said the new language would allow the 12 states that ban abortion coverage in public plans and the five that ban such coverage in both public and private plans to continue doing so. The proposal would also require health-care exchanges to offer at least one plan that doesn't cover abortions.

Public Option Alternative

The Nebraska lawmaker and other Democrats had also objected to a plan to create a new government-run program, or public option, to compete with private insurers such as Hartford, Connecticut-based Aetna Inc. By eliminating that provision from the bill, Reid was able to win over holdouts including Connecticut Senator Joe Lieberman, an independent who caucuses with the Democrats.

As an alternative, the U.S. Office of Personnel Management, which oversees benefits for all civilian federal workers and members of Congress, would contract with private insurers to offer multistate plans on the insurance exchange.

Nelson won another prize for his state, with additional Medicaid costs to Nebraska being absorbed by the federal government. Reid said he had been working for weeks on the provision and said it was a "minor part" of the negotiations with Nelson.

All About 'Compromise'

"A number of states are treated differently than other states," Reid told reporters. "That's what legislation is all about. Compromise."

The statesexcept Nebraskawill have to pay 10 percent of the additional costs of Medicaid after 2017. Before that the federal government will pay 100 percent.

Among the other revisions: As soon as the legislation is enacted, children couldn't be denied insurance coverage because of a pre-existing medical condition, the summary said. Patients could also appeal decisions to deny a coverage claim to an independent board.

Reid's proposal would also force insurers to give consumers rebates if they pay less than 85 percent of premiums for medical care to beneficiaries in group plans or less than 80 percent in individual market, according to a text of the legislation.

Expenses such as taxes and fees could be deducted before calculating the percentage and the health secretary could grant exemptions if the law threatened to disrupt a local market, the bill said.

The bill also drops plans for a levy on cosmetic surgery, proposing instead a 10 percent tax on indoor tanning booths.

Plastic surgeons joined forces with companies led by Allergan Inc., maker of the wrinkle smoother Botox as well as silicone breast implants, to fight the proposed fee. The 5 percent "Bo-tax," as it was jokingly dubbed, was projected by Senate Democrats to raise $6 billion over 10 years.

With Reid unveiling the bill, the senators will take three votes separated by 30-hour intervals over the next week, assuming Republicans use their procedural delays.

Holdout Senator Agrees To Support Health Care Bill

Sen. Ben Nelson's support gives Democrats the 60 votes needed to clear the way for Senate passage of sweeping health care legislation.