WASHINGTON – The Senate opened debate Monday on landmark health care legislation that would extend coverage to millions of uninsured and ban onerous insurance practices, with Democrats vowing to work weekends to deliver on President Barack Obama's domestic initiative by year's end.
"There's not an issue more important than finishing this legislation," Majority Leader Harry Reid, D-Nev., told his colleagues in putting them on notice for Saturday and Sunday sessions in December.
Reid said exorbitant health care costs have forced thousands of Americans into bankruptcy, creating an economic crisis that Congress must address.
However, Republican Leader Mitch McConnell of Kentucky said the $979 billion, 10-year Senate bill is too expensive for a nation struggling financially.
"The notion that we would even consider spending trillions of dollars we don't have in a way that the majority of Americans don't even want is proof that this health care bill is out of touch," McConnell said.
The first amendment offered to the bill, by Sen. Barbara Mikulski, D-Md., would make the legislation even more expensive by reducing copays and deductibles for preventive services for women, such as mammograms.
The Obama administration had to tamp down outrage earlier this month after a government-appointed panel said that women generally should begin routine mammograms in their 50s rather than their 40s. Mikulski said that under her amendment, "if your doctor says you need one, you're going to get one." She said her amendment would cost about $1 billion.
Coinciding with the start of debate, congressional budget experts said the bill would lower the average price of insurance premiums if it passes, although millions would face higher costs.
According to the Congressional Budget Office, the legislation would raise premiums on non-group policies by an average of 10 percent to 13 percent before figuring in the federal subsidies that are designed to defray the cost. Once the government aid is included in the calculations, average premiums would be as much as 59 percent lower than is now the case.
The CBO says the bill would have a far smaller impact on the cost of small group and large group insurance.
Democrats face near unanimous Republican opposition to the health care measure — and deep divisions within their own ranks.
While majority Democrats will need 60 votes to finish, some in the party say they'll jump ship from the bill without tighter restrictions on abortion coverage. Others say they'll go unless a government plan to compete with private insurance companies gets tossed. Such concessions would enrage liberals, the party's heart and soul.
There's no clear course for Reid to steer legislation through Congress to the president's desk.
Reid's bill gradually expands coverage to most of those now uninsured. It would ban insurance industry practices such as denying coverage or charging higher premiums because of someone's poor health. Those who now have the hardest time getting coverage — the self-employed and small businesses — could buy a policy in a new insurance market, with government subsidies for many. Older people would get better prescription coverage.
Most people covered by big employers would gain more protections without major changes. One exception would be those with high-cost insurance plans, whose premiums could rise as a result of a tax on insurers who issue the coverage.
Moderate senators who will be critical to the outcome were already coming under pressure. The group Conservatives for Patients Rights began running an ad targeting 14 centrist lawmakers and urging voters to tell them to oppose a government insurance plan. The group is spending an initial $250,000 to air the ad for a week on CNN and Fox News Channel.
The Senate bill would establish government-run insurance but allow states to opt out.
The public is ambivalent about the Democrats' legislation. While 58 percent want elected officials to tackle health care now, about half of those supporters say they don't like what they're hearing about the plans, according to a new Kaiser Family Foundation poll.
Each side planned to offer an amendment. No votes were scheduled Monday.
Reid wants to finish by Christmas; he may not get to.
Of the many issues senators have to weigh, abortion funding and the option of a government insurance plan promise to be the most difficult. On abortion, no compromise seems possible. On the public plan, a deal may yet be had.
On the Net:
Comparing the House and Senate bills: http://tinyurl.com/yeshhgv
Kaiser Family Foundation: http://healthreform.kff.org/