WASHINGTON — Senate Democratic leader Harry Reid unveiled his long-awaited version of legislation to reshape the nation's health care system Wednesday night, a measure designed to extend coverage to 94 percent of eligible Americans and bar private industry from denying insurance because of pre-existing medical conditions.
"Tonight begins the last leg of this journey," said the Nevada Democrat, less than two weeks after the House approved its version — and nearly 10 months after President Barack Obama's Inauguration Day summons to action.
A Senate aide said Reid's measure would cost $849 billion over 10 years. Reid promised that it would reduce the federal budget deficit while covering most of the uninsured and adding new benefits to Medicare.
Aides said Reid hoped to take an important procedural vote to begin debate on the legislation before senators leave town for a weeklong Thanksgiving break.
Senate Democratic leaders are still trying frantically to nail down the final votes needed to begin debate on the legislation. To do so, they need the unanimous support of all 60 members of their caucus, a huge test of Reid's leadership skills.
And at least two potential Democratic holdouts — Sens. Mary Landrieu of Louisiana and Ben Nelson of Nebraska — signaled on Wednesday that they were open to supporting a motion to begin debate.
If the Democrats succeed in pulling together the needed votes, the Senate intends to devote most of December to a rollicking, unpredictable debate that could determine the fate of legislation that Obama has declared to be his top domestic priority.
Vice President Joe Biden and Interior Secretary Ken Salazar, both former senators, were on Capitol Hill on Wednesday, trying to help Reid round up votes.
Republicans have vowed to fight the legislation at every turn, saying it represents a dangerous expansion in the role of government that would increase taxes and insurance costs for millions of people.
"It's going to be a holy war," said Sen. Orrin Hatch, R-Utah, one of his party's most respected voices on health policy who for the past several months has voiced nothing but fury over the Democrats' efforts.
Reid's measure would require most Americans to carry health insurance and would provide hundreds of billions of dollars in subsidies to help those at lower incomes afford it. It also would mandate that large companies provide coverage to their workers.
At its core, it would set up new insurance marketplaces — called exchanges — primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government-sold insurance, an attempt to hold down prices charged by private insurers.
The senior Senate Democratic leadership aide said the bill's costs would be more than offset by new taxes and reductions in government spending, particularly on Medicare, so that the legislation would reduce future federal deficits by $127 billion.
The official cost analysis by the nonpartisan Congressional Budget Office was not immediately available, but if the cost projection holds up, it would meet Obama's requirement that the bill's costs be held to about $900 billion. Reid presented the bill at a meeting with his fellow Democrats.
The measure includes a so-called public option allowing people to buy into a new government health insurance plan, but states could opt out of that.
Though similar to the House bill, Reid's proposal is expected to differ in important ways. It is, for example, likely to increase the Medicare payroll tax on high-income people and to impose a new excise tax on high-cost "Cadillac" health plans.
Reid's bill would not go as far as the House-passed bill in limiting insurance coverage for abortions. And while he would require most Americans to obtain health insurance, his bill would impose less stringent penalties for violations.
Reid's bill would create a voluntary federal program to provide long-term care insurance and cash benefits to people with severe disabilities. The program, known as Community Living Assistance Services and Supports, would be financed with premiums.
The premiums would be set to cover the full cost of the benefits, which, according to the Congressional Budget Office, would average $75 a day. The House-passed bill includes similar provisions.
William Minnix Jr., president of the American Association of Homes and Services for the Aging, a trade group, said the new benefit could be immensely helpful to stroke victims and people with spinal cord injuries and those with Alzheimer's or Parkinson's disease.
The Senate bill was expected to increase the Medicare payroll tax on high-income workers. Under current law, employers and employees each pay a tax equal to 1.45 percent of wages.
The plan contemplated by Reid would increase the tax rate for people earning more than $250,000 in an attempt to raise $40 billion to $50 billion over 10 years.
Under a bill approved last month by the Senate Finance Committee, the government would impose a 40 percent tax on the value of insurance exceeding $8,000 for individual coverage and $21,000 for family coverage, with some exceptions.
The House bill, which passed 220 to 215, with just one Republican joining 219 Democrats in support, relies on an income surtax on individuals earning more than $500,000 a year, and couples earning more than $1 million to pay for the legislation.