The pivotal Senate Finance Committee was poised to approve sweeping legislation Tuesday requiring nearly all Americans to purchase insurance and ushering in a host of other changes to the nation's $2.5 trillion medical system.
Much work would lie ahead before a bill could arrive on Mr. Obama's desk, but action by the Finance Committee would mark a significant advance, capping numerous delays as Chairman Max Baucus, D-Mont., held marathon negotiating sessions - ultimately unsuccessful - aimed at producing a bipartisan bill.
Four other congressional committees acted before August to pass health legislation, so for months all eyes have been on the Finance Committee, the remaining one. It's also the panel whose moderate makeup most closely resembles the Senate as a whole. And the committee's centrist legislation is seen as the best building block for a compromise plan that could find favor on the Senate floor.
With Democrats holding a 13-10 majority on the committee the outcome of Tuesday's vote is not in doubt. The big question mark is whether moderate Sen. Olympia Snowe of Maine will become the first Republican to support a health overhaul bill. The legislation that passed the other House and Senate committees did so without a single Republican vote. On Monday, Snowe still wasn't saying.
With Finance Committee passage, Mr. Obama's top domestic priority will have advanced farther than former President Bill Clinton's effort ever did. The Clinton health plan never made it through all the congressional committees with jurisdiction.
The final days before Tuesday's long-anticipated vote were rocky. After playing nice for months, the health insurance industry released a report contending that the legislation would cause hefty increases in health insurance premiums.
Democrats and their allies. "Distorted and flawed," said White House spokeswoman Linda Douglass. AARP's senior policy strategist, John Rother, called it "fundamentally dishonest."
The White House insists the bill would bring health insurance costs down. However, Paul Ginsburg, a non-partisan analyst at the Center for Studying Health System Change, told CBS News Chief White House Correspondent Chip Reid the insurance companies do have a point.
"If people aren't mandated to buy insurance, then you will get a situation where people stay uninsured until they get sick," Ginsburg told Reid.
The drama threatened to overshadow the vote on the 10-year, $829-billion plan that Baucus has touted as the sensible solution to America's problems of high medical costs and too many uninsured.
The bill includes consumer protections such as limits on co-pays and deductibles and relies on federal subsidies to help lower-income families purchase coverage. Insurance companies would have to take all comers, and people could shop for insurance within new state marketplaces called exchanges.
Medicaid would be expanded, and though employers wouldn't be required to cover their workers, they'd have to pay a penalty for each employee who sought insurance with government subsidies. The bill is paid for by cuts to Medicare providers and new taxes on insurance companies and others.
Unlike the other health care bills in Congress, Baucus' would not allow the government to sell insurance in competition with private companies, a divisive element sought by liberals.
Last-minute changes made subsidies more generous and softened the penalties for those who don't comply with a proposed new mandate for everyone to buy insurance. The latter change drew the ire of the health insurance industry, which said that without a strong and enforceable requirement not enough people would get insured, and premiums would jump for everyone else.
America's Health Insurance Plans commissioned a study to prove just that, alleging the bill would add thousands of dollars to a typical policy. It was timed just ahead of the vote on Baucus' bill but the industry was already looking ahead to negotiations on a final package to bring to the Senate floor.
Once the Finance Committee has acted, the dealmaking can begin in earnest with Senate Majority Leader Harry Reid, D-Nev., working with White House staff, Baucus and others to blend the Finance bill with a more liberal version passed by the Health, Education, Labor and Pensions Committee.
A major question mark is whether Reid will include some version of a so-called public plan in the merged bill. Across the Capitol, House Democratic leaders are working to finalize their bill, which does contain a public plan, and floor action is expected in both chambers in coming weeks. If passed, the legislation would then go to a conference committee to reconcile differences.