WASHINGTON — The next 48 hours will be critical to the fate of health care reform in the Senate, as Democratic leaders struggle to settle disputes that stand in the way of holding a final vote this year on the massive package.
By mid week, Senate Majority Leader Harry Reid, D-Nev., must begin the process of ending debate on the $848 billion bill or risk missing his deadline of final passage by Christmas, pushing the contentious debate into early 2010.
Reid must secure 60 votes to defeat the series of procedural votes that Democrats expect their GOP opponents will force. But with little time to spare, he is still struggling to convert a handful of holdouts.
Most of the undecided lawmakers have refused to commit until the Congressional Budget Office delivers a cost analysis on the coverage alternatives offered last week by a group of five liberal and five conservative Democrats to replace the government insurance option originally included in the legislation.
On Sunday afternoon, one member of the Democratic caucus — independent Sen. Joe Lieberman of Connecticut — informed Reid that he would oppose the bill if it includes one of the proposals the group advanced, a plan to allow individuals over age 55 to buy into Medicare.
Olympia Snowe of Maine, the only Republican to support Democratic reform efforts and the most likely 60th vote if Lieberman defects, is also skeptical of the Medicare buy-in idea. Should the CBO results fail to allay either senator's concerns, Reid will be forced to drop the Medicare provision to keep the bill moving forward — a move sure to incite liberal senators who have already seen the Democratic leadership jettison the public option.
Undecided Democrats insist that none of the remaining obstacles appear to be insurmountable. But they concede that time is running short.
"It's uphill," Sen. Ben Nelson, D-Neb., one of the undecideds, said of the challenge facing Reid. "There are so many people who are committed to the legislation pretty much as it is. I don't know how flexible they may be."
Senate Minority Leader Mitch McConnell, R-Ky., said Democrats are losing momentum.
"With the American people as overwhelming opposed to this bill as they are, for the Democrats to basically arrogantly take the position that we're going to ignore public opinion and jam this through before Christmas, I think that's really a stretch," McConnell said Sunday morning on Face the Nation.
The first test will come today, when the Senate resumes consideration of an amendment offered by Sen. Byron Dorgan, D-N.D., to allow cheaper prescription drugs to be imported from Canada and other countries. The idea has broad bipartisan support. But approval of Dorgan's amendment could jeopardize an agreement the White House struck with drugmakers this year that has helped to ease health care industry opposition to the bill.
Democratic leaders also have not satisfied concerns raised by Nelson over the availability of abortion coverage in the Senate legislation. Nelson has said he would vote with Republicans to filibuster the Senate bill unless the current language is tightened.
"I'm encouraged that they're trying to do something about it," Nelson said of Democratic leaders, although he added, "nobody's coming back to me with language." Sen. Barbara Boxer, D-Calif., one of the negotiators on the abortion provisions, said she was optimistic that middle ground would be found. "It looks like we're making some progress," she said Sunday.
The wait for the CBO report created a rare lull in a debate that otherwise has advanced briskly through the fall. "Everything's on hold until we get the CBO analysis," said Sen. Kent Conrad, D-N.D. "That'll be the defining moment. We'll see what the combined effect of all these things is, that have been added in recent days, and until you see that, I don't think people can form a judgment."
Nelson bristled at complaints from some of his Democratic colleagues that he has extracted multiple concessions but had still not committed to the bill. "I'm not looking for ways to just be against this legislation, or I wouldn't have become a friend of the process," he said.