Bruising debate on health care awaits Senate

WASHINGTON — A bruising debate on health care awaits the Senate after Thanksgiving now that the historic legislation has cleared a key hurdle over the opposition of Republicans eager to inflict a punishing defeat on President Barack Obama.

The bill would extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

In the final minutes of a daylong session, Majority Leader Harry Reid, D-Nev., accused Republicans of trying to stifle a historic debate the nation needed.

The Republican leader, Sen. Mitch McConnell of Kentucky, said the vote was anything but procedural — casting it as a referendum on the bill itself, which he said would raise taxes, cut Medicare and create a "massive and unsustainable debt."

Two final Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate.

"It is clear to me that doing nothing is not an option," said Landrieu, who won $100 million in the legislation to help her state pay the costs of health care for the poor.

Landrieu and Lincoln, who faces a tough re-election next year, both stressed they were not committing in advance to vote for the legislation that ultimately emerges from next month's debate.

Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval — a part of Reid's bill expected to come under significant pressure as the debate unfolds.

White House press secretary Robert Gibbs said the president was gratified by the vote, which he says "brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it."

The legislation would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their workforce. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.

Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.