WASHINGTON - (AP) - A holdout no more, Sen. Ben Nelson agreedSaturday to provide the 60th and deciding vote for sweeping healthcare legislation in the Senate, capping a year of struggle and afinal burst of deadline bargaining on President Barack Obama's topdomestic priority.
Nelson, D-Neb., said he made his decision after winning freshconcessions to limit the availability of abortions in insurancesold in newly created exchanges, as well as tens of million infederal Medicaid funds for his home state.
He also noted he had successfully fended off attempts to providefor a government-run insurance option to compete with privateinsurers.
One Democratic official said an analysis by the CongressionalBudget Office to be released later Saturday would estimate adeficit savings of more than $130 billion over 10 years, and thepossibility of much more in the subsequent decade.
Forecasters said the bill would expand coverage to roughly 94percent of eligible Americans under age 65, a total that excludesillegal immigrants. The official who described the conclusionsspoke on condition of anonymity, saying he lacked authorization topre-empt the release of the report.
With Nelson's decision, Obama's Senate allies appear on track topass the legislation by Christmas, overcoming unanimous Republicanopposition and a swirling early winter snowstorm.
At its core, the measure is designed to spread coverage to tensof millions who lack it, while banning insurance company practicessuch as denial of coverage on the basis of pre-existing medicalconditions. The White House also wants the legislation thateventually makes it through Congress to slow the rate of growth innational medical spending overall. The House passed its version ofthe legislation last month, and final compromise talks are expectedquickly.
Nelson disclosed his decision as Majority Leader Harry Reid,D-Nev., unveiled a final series of changes designed to solidifysupport.
The legislation includes new limits designed to limit insurancecompany profits and overhead, by requiring them to spend 80 percentof their premium income on medical care for individual insurancepolicies, and 85 percent for group policies. The industry says sucha limitation is unnecessary because profits generally are in thesingle digits.
The estimated 30 million Americans purchasing coverage throughnew insurance exchanges would have the option of signing up fornational plans overseen by the same office that manages healthcoverage for federal employees and members of Congress. Those planswould be privately owned, but operated on a nonprofit basis, asmany Blue Cross Blue Shield plans are now.
The option amounts to a consolation prize for liberals, whofailed to include a government-run alternative.
Additionally, insurance companies would be barred immediatelyfrom denying coverage to children because of a pre-existing healthcondition. The prohibition on denial of coverage for adults wouldnot take effect in the Senate bill until 2014, a disappointment forconsumer advocates.
On abortion, the measure would let a state disallow coverage innew insurance exchanges by passing a law to that effect.Additionally, it sets up a mechanism to segregate funds that wouldbe used to pay for abortions from federal subsidy dollars flowingto health plans.
Federal law now prohibits public money for abortions, except incases of rape, incest or to save the life of the mother. From thebeginning, the issue has been how those restrictions would beapplied to a new stream of federal money under the overhaul bill.
The developments occurred as Republicans dug in to delay theinevitable for as long as possible. They objected when Reid soughtpermission for Nelson to announce his decision in a speech on theSenate floor, then forced Senate clerks to spend hours readingaloud the text of the 383-page package of changes.
Republican opposition, coupled with Senate rules requiring 60votes to overcome a filibuster, gave Nelson enormous leverage as hepressed for concessions that included stronger restrictions onabortions to be covered by insurance policies offered in a newlyoverhauled health care system.
The final agreement with Nelson was sealed late Friday nightafter marathon negotiations in Reid's Capitol office a few stepsoff the Senate floor. Reid telephoned Obama with the news.
Officials said the federal government would pick up Nebraska'sentire cost of a Medicaid expansion in the bill. Other states willhave to begin picking up a portion of the added expanse beginningin 2017.
Nelson already rejected one proposed offer on abortions asinsufficient, and the presence in the talks of Sen. Barbara Boxer,D-Calif., indicated additional changes were on the table.
Boxer has a strong record in favor of abortion rights. She toldreporters as she left the Capitol at the end of Friday eveningthere had been progress made on the issue of separating personalfunds, which may be used to pay for abortions, from federaldollars, which may not.
Obama devoted his weekend radio and Internet address to theissue he campaigned on in 2008.
"Now - for the first time - there is a clear majority in theSenate that's willing to stand up to the insurance lobby andembrace lasting health insurance reforms that have eluded us forgenerations," Obama said.