The US Senate was poised to formally launch a historic and bitter debate Monday on sweeping legislation to overhaul the country’s health care system, President Barack Obama’s top domestic priority.
Obama’s Republican foes were united against the plan, forcing his Democratic allies to hold difficult behind-the-scenes negotiations to bridge internal divisions and rally the 60 votes needed to ensure passage.
Democratic Senate Majority Leader Harry Reid needed to unite all 58 Democrats and two independents who often side with the party to overcome Republican parliamentary delaying tactics that could derail the bill.
With senators expected to push dozens of amendments, the debate was expected to take weeks, perhaps pushing it beyond Reid’s Christmas target date for a Senate vote on the broadest such overhaul in four decades.
“We need 60 votes at some point to end debate and will try to do that at some point,” said Reid spokesman Jim Manley, who predicted Democratic amendments “to improve and clarify” some aspects of the legislation.
The measure includes a government-backed insurance program to compete with private firms, tough new restrictions on dropping care for pre-existing ailments, and an end on lifetime caps for coverage.
It is estimated to cost 848 billion dollars through 2019 but cut the sky-high US budget deficit by 130 billion dollars over the same period, according to the non-partisan Congressional Budget Office.
Senate approval of the measure would force the Senate and House of Representatives to reconcile their rival versions of the bill and vote again on whether to send it to Obama.
Reid’s main challenge came from three possible Democratic defectors, Senators Mary Landrieu, Blanche Lincoln, and Ben Nelson, and from former Democrat turned Independent Senator Joe Lieberman.
Landrieu, Lieberman and Lincoln have signaled they will side with Republicans to block a final vote on the bill if it includes a government-backed “public option” for health care coverage to compete with private insurers.
Nelson has said he will oppose the bill unless lawmakers include sharply tougher restrictions on even indirect government funding going to insurers who cover abortion — mimicking a last-minute deal that paved the way for House passage of the legislation.
With such tenuous Democratic backing, Reid and the White House have courted several centrist Republicans whose support could also help them sell the bill as a bipartisan measure.
Support from Maine Republican Senators Olympia Snowe and Susan Collins are top priorities for Democrats, and Snowe has already publicly indicated some willingness to vote in favor of health reform if certain conditions are met.
The United States is the world’s richest nation but the only industrialized democracy that does not provide health care coverage to all of its citizens, about 36 million of whom are uninsured.
Washington spends more than double what Britain, France and Germany do per person on health care, but lags behind other countries in life expectancy and infant mortality, according to the Organization for Economic Cooperation and Development (OECD).
