"We're not going to not pass a bill," said Sen. Charles Schumer, D-N.Y. With or without Republican support, Democrats will get it done, Schumer said, because a health care system that leaves nearly 50 million uninsured and spends more than any other is clearly broken.
Republicans wasted no time Monday going after Democratic moderates who delivered a Senate victory Saturday for President Barack Obama. The 60-39 vote overcame a procedural hurdle and allowed floor debate to start after Thanksgiving. Senate Democrats hope to finish their bill by Christmas, but it remains to be seen whether Obama gets final health care legislation this year.
A state Republican Party leader accused Sen. Ben Nelson, D-Neb., of trying to have it both ways by talking conservative back home and voting with liberals in Washington.
"Nebraskans are finally wising up that there are two Ben Nelsons," said Nebraska GOP Chairman Mark Fahleson. "There's the Washington Ben Nelson ... who gave Democrats the vote they wanted. Then there's the Nebraska Ben Nelson ... who come back here to Nebraska and tries to portray himself as a conservative."
Nelson's office had no response, but the Democrat has said he won't vote for a final bill unless it takes into account his concerns about limits on abortion funding, as well as his opposition to a new government-run insurance plan.
Another moderate Democrat, Sen. Blanche Lincoln of Arkansas, said Monday she also could not support "a government-run, government-funded" public plan. With hundreds of thousands of uninsured people in her state eligible for existing government programs such as Medicaid, getting them signed up should be the first priority.
Democrats hope to persuade at least one Republican, Maine Sen. Olympia Snowe, to vote for the final bill. But Snowe voted with Republicans on Saturday to block Majority Leader Harry Reid's 10-year, $979 billion bill from coming to the floor.
Reid, D-Nev., will have to resolve differences within his party over abortion, taxes and letting the government sell health insurance as a competitor with private insurers. Another 60-vote test awaits him at the end of the debate, weeks from now. The House has already passed its version.
Both bills would require all Americans to carry health insurance, with government help to make premiums more affordable. They would ban insurance companies from denying coverage or charging more to people with health problems. They would set up new insurance markets for those who now have the hardest time finding and keeping coverage - self-employed people and small businesses. Americans insured through big employer plans would gain new consumer protections but wouldn't face major changes. Seniors would get better prescription coverage.
They differ on abortion, taxes and the public plan.
If Democrats succeed in passing their legislation, it may leave consumers feeling a little cheated. Even after a phase-in of several years, the Democratic measures would leave 12 million or more eligible Americans uninsured. Many middle-class families who'd be required to buy coverage would still find the premiums a stretch, even with government aid. A new federal fund to provide temporary coverage for people with health problems would quickly run out of cash.
On abortion funding, the House adopted strict limitations as the price for getting anti-abortion Democrats to vote for the final bill. Abortion rights supporters are backing Reid's approach in the Senate bill, which tries to preserve coverage for abortion while stipulating that federal dollars may not be used except in cases of rape, incest, or to save the life of the mother.
In the end, Reid may have to bend. Catholic bishops say they can't accept his approach because it would let federally subsidized plans cover abortion. They vow to oppose the health care bill unless, like the House, the Senate enacts stronger language. Democratic senators opposed to abortion are already threatening a battle.
On financing, the House relies mainly on an income tax hike for upper-earners to pay for expanded coverage. The Senate opted for a tax on high-cost insurance plans, a Medicare payroll tax hike on the wealthy and fees on medical industries. In polls, the House approach is more popular. The Obama administration has signaled it likes the Senate's insurance tax.
That leaves the controversy over creating a government health plan to compete with the insurance industry. It has dominated the debate and remains unresolved.
Both House and Senate bills now provide for a government insurance plan, but Reid's bill would let states opt out. It's not clear that Reid has the votes. He may be able to get a compromise to allow a government plan only if, after a reasonable time, insurance companies fail to deliver lower premiums.
In advance of the Senate debate, the American Medical Association and AARP announced a new ad aimed at calming seniors' fears over Medicare. It features a white-coated man identified as a "real doctor" countering claims from another man identified as a "spin doctor" and will air nationally for two weeks.
Schumer appeared on NBC's 'Today' show on Monday.