After Health Care Win, Debate Continues

President Barack Obama won an important victory on his biggest domestic issue as a pivotal Senate panel endorsed a bill to overhaul the U.S. health care system.

The Senate Finance Committee vote Tuesday gave a boost to Mr. Obama, who has made passage of a health care bill the signature issue of the first year of his presidency.

Mr. Obama's success or failure could shape next year's congressional elections and determine whether he has the political clout to prevail on global warming, Afghanistan war policy and other critical issues.

On Wednesday, the health care talks will again slip back behind closed doors as Senate leaders start trying to merge very different bills into a new version that can get the 60 votes needed to guarantee its passage.

All eyes are on Senate Majority Leader Harry Reid of Nevada, who has said he wants to get historic health care overhaul legislation onto the floor the week after next.

Both bills were written by Democrats, but that's not going to make it easier for Reid. They share a common goal, which is to provide all Americans with access to affordable health insurance, but they differ on how to accomplish it.

The Finance Committee bill that was approved Tuesday has no government-sponsored insurance plan and no requirement on employers that they must offer coverage. It relies instead on a requirement that all Americans obtain insurance.

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The Senate Health, Education, Labor and Pensions Committee bill, passed earlier by a panel in which liberals predominate, calls for both a government plan to compete with private insurers and a mandate that employers help cover their workers. Those are only two of dozens of differences.

At the White House, Mr. Obama called the vote "a critical milestone" toward remaking America's health care system and declared, "We are going to get this done."

Mr. Obama wasn't ready to bask in the bipartisan glow.

"Now is not the time to pat ourselves on the back," he said. "Now is the time to dig in and work even harder."

Still, nearly nine months after the president pledged in his inaugural address to tackle health care legislation to expand coverage to millions of people who lack it, a bill now has advanced further than President Bill Clinton's ill-fated effort more than a decade ago.

Despite the vote, Mr. Obama still faces a lengthy, uncertain legislative process in winning approval for a plan aimed at making health insurance affordable and more widely available. The U.S. is the only industrialized country without universal health care coverage, and about 47 million Americans are uninsured.

The full Senate will now consider the health plan, combining the Finance Committee version with a more liberal proposal from the health committee. The House of Representatives is working on its own plan. If the two chambers manage to pass bills, the two versions would have to be reconciled.

Though Democrats have strong majorities in both chambers, they are divided about what provisions the bill should contain. Meanwhile, Republicans are almost unanimous in their opposition and could try procedural tactics to derail the bill in the Senate.

But in a hopeful sign for Mr. Obama, one Republican - Olympia Snowe - joined the 13 Democrats on the Finance Committee in voting for the plan. The nine other Republicans voted against it. But Snowe's support could be critical in getting the plan through the Senate.

The Maine senator made clear, though, that her support is not assured in the future.

"My vote today is my vote today. It doesn't forecast what my vote will be tomorrow," she said.

Snowe's vote is important to President Obama not only because it gives health care reform an air of bipartisanship but he will need her help to ultimately pass a bill, reports CBS News correspondent Nancy Cordes.

Asked why she voted for the bill, Snowe, who called the debate "bipartisan" and "intensive," told CBS' "The Early Show", "I thought it was important to move this process forward."

The Finance Committee bill was seen as perhaps the most politically viable of several plans considered by lawmakers. It would, for the first time, require most Americans to purchase insurance. It also aims to hold down spiraling medical costs over the long term.

Across the Capitol, Speaker Nancy Pelosi and her lieutenants have been at work for weeks trying to blend legislation approved by three House committees. The eventual result is certain to include a government insurance option.

Republicans opposed Democratic plans, charging they would raise taxes, widen the deficit and reduce the quality of health care. Democrats countered that Republicans were motivated by politics, looking to bring down Mr. Obama's presidency.

Republican Sen. Charles Grassley said the legislation would place the country on a "slippery slope to more and more government control of health care."

Snowe, too, said there were problems with the bill, but on balance, the risks of doing nothing were too great.

"We should also contemplate the decades of inaction that have brought us to this crossroads," she said. "The status quo approach has produced one glaring common denominator, that is that we have a problem that is growing worse, not better."

When the Senate floor debate starts, Republicans, while a minority, still hold sufficient votes to stall passage through a delaying procedure known as a filibuster.

That move is expected and would require majority Democrats to muster all 60 of their votes, not a simple majority of 51, to end debate and bring a bill to a final vote. Some fiscally conservative Democrats are opposed to the bill coming out of the committee, so that gaining the 60 votes to break a filibuster is far from certain.

Apart from the details of the emerging bills, there were signs that the political struggle was intensifying.

Within minutes of the Finance Committee vote, labor unions and large business organizations both demanded changes in the bill, which was an attempt at a middle-of-the-road measure fashioned under the leadership of Sen. Max Baucus, the committee chairman.

Several officials, speaking on condition of anonymity, said business groups were discussing plans to step up their opposition to legislation. The health insurance industry made clear its own unhappiness on Monday when it released a study by the auditing firm, PricewaterhouseCoopers, saying the Finance Committee bill would raise premiums significantly for millions who already have insurance.

The report drew criticism from the White House, Democrats in Congress and other advocates of the legislation. By Monday night, the auditing firm appeared to backpedal, issuing a statement acknowledging its report was based only on an analysis of four provisions in the proposed legislation.

In general, bills moving toward floor votes in both houses would require most Americans to purchase insurance, provide federal subsidies to help those of lower incomes afford coverage and give small businesses help in defraying the cost of coverage for their workers.

The measures would bar insurance companies from denying coverage on the basis of pre-existing medical conditions and for the first time limit their ability to charge higher premiums on the basis of age or family size.