Senate Health Bill Faces Crucial Vote

Last Updated 3:36 p.m. ET

Democratic leaders secured the last two votes to move ahead on historic health care legislation, clearing the way for a Saturday night showdown on President Barack Obama's top domestic initiative.

In long-awaited speeches, Senators Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana said they would stand with their party and vote "yes" on the crucial test vote despite their reservations with elements of the 2,074-page bill aimed at remaking the nation's health care system.

The two represent votes 59 and 60 for Senate Majority Leader Harry Reid, D-Nev., who needs that many in the 100-member Senate to go forward.

The Senate's 40 Republicans are unanimously opposed.

Landrieu called the bill "the best work of the Senate to date and subject of significant importance to the people of my state and the country," and said she would vote yes to move forward on debate.

"Over the past many years and in particular the last six months, I have heard from people all across Louisiana that their insurance premium costs are simply too high and continue to rise without warning, threatening the financial stability of their families and their businesses," Landrieu said.

"I have also heard the pleas and cries of many people who need coverage, health coverage, but they can't find it anywhere within reach of their budgets. Through months of public meetings in VFW halls, school gyms and in hospitals and health clinics from New Orleans to Shreveport, in large and small communities throughout my state, it is clear to me that doing nothing is not an option - nor is waiting any longer for this debate to begin, to continue, and to come to some final conclusion."

Landrieu said she would reserve her ultimate vote pending the final bill.

Lincoln also said she would support the continued debate, even though she said she does not support legislation with a government-back insurance plan.

"The reason we are having this vote," Lincoln said, "is because our Republican colleagues object to beginning debate and consideration of amendments on health care legislation. Although I don't agree with everything in this bill, I have concluded that I believe it is more important that we begin this debate to improve our nation's health care system for all Americans, rather than just simply drop the issue and walk away. It's not what people sent us here to do.

"My first loyalties are with the people of Arkansas, not insurance companies, the health care industry, or my political party," Lincoln said.

A third centrist, Democratic Sen. Ben Nelson of Nebraska, announced Friday that he'd be supporting his party on the test vote, while cautioning that it didn't mean he'd be with them on the final vote.

"It is not for or against the new Senate health care bill," Nelson said. "It is only to begin debate and an opportunity to make improvements. If you don't like a bill, why block your own opportunity to amend it?"

The vote is scheduled for 8 p.m. EST Saturday.

Democrats called a revamp of the nation's health care system long overdue.

"The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," Sen. Patrick Leahy, D-Vt., said today.

Debate seems not an option for Republicans, who are uniformly opposed to the legislation. Not a single GOP Senator, so far, is even willing to vote to talk about it.

Instead, Sen. John Cornyn of Texas said, "I think what we need to do is kill this bill,"

Republicans and some conservative Democrats have voiced opposition to the Reid bill's plan to expand health care coverage through a government-backed "public option." Republicans used their weekly radio and Internet address to slam the legislation, calling it a government takeover of health care that would increase taxes and raise medical costs.

"This 2,000-page bill will drive up the cost of health care insurance and medical care, not down," Sen. Mike Crapo, R-Idaho, said in the address. "This is not true health care reform, and it is not what the American people want. This bill will result in higher premiums and higher health care costs for Americans - period."

However, Sen. Bernie Sanders, I-Vt., said a public option is necessary.

"The current system is unsustainable," Sanders said on CBS' "The Early Show" this morning. "Forty-six million uninsured, 45,000 Americans dying every year because they don't have access to a doctor. We have almost 1 million Americans going bankrupt because of medically-related diseases and we end up spending twice as much per person on health care as any other nation. This is unsustainable. We need real health care reform."

Sanders said he appreciates the frustrations of many about how the process has been moving. "I think that's a fair point: It is much more complicated than it should have been," he said. "I think it has gone on for longer than it should have gone on. But I think at the end of the day, what people know is that we do need reform."

Sanders, who will vote for debate of the bill, said he is withholding a decision about the final bill unless it contains a single payer provision, "which guarantees health care to every man, woman and child as a right.

"The American people know that the current system is unsustainable. Health care costs are soaring. We cannot be the only country in the world that does not guarantee health care for all people. So we've got to move forward.

"Get rid of the hundreds, [many] billions of dollars that we are wasting through the administration and profiteering of private insurance companies," Sanders said. "It could have been simple, it could have been short: Guaranteed health care to all people, save money, and I think that would have been a more popular way to go."

A recent CBS News poll shows Americans disapprove of the way Democrats and Republicans are handling health care, with disapproval reaching 60 and 67 percent respectively. In addition, more than two-thirds of Americans - 69 percent - think Republicans are not serious about reform.

To critics of the public option, Sanders said, "To my mind, you need to strengthen the public option, you need to give competition to the private insurance company whose only function is to get make as much money as possible. We have to get a handle on soaring health care costs. Giving people an option is one important way. I'm going to fight to strengthen the public option which in truth is pretty weak in the Senate bill."

The Congressional Budget Office estimates it will cost about $850 billion over ten years - far less than the $1.1 trillion house version. Like the House bill, it requires most Americans to buy coverage through their employer, privately or through a public plan.

Democrats said their legislation could make historic and necessary improvements in the country's social safety net.

"Prices of health care are marching relentlessly upwards, and so too many people don't have coverage," said Sen. Byron Dorgan, D-N.D. "The purpose of all of this is to try to get a handle on it somehow."

The White House issued a statement late Friday praising the Senate measure. "This bill provides the necessary health reforms that the administration seeks - affordable, quality care within reach for the tens of millions of Americans who do not have it today, and stability and security for the hundreds of millions who do," the statement said.

The White House had hoped to have a health care bill on the president's desk by the end of the year. Now they're talking about trying to get it done before his State of the Union address early next year, so they can focus the president's attention elsewhere.

The action in the Senate comes two weeks after the House approved a health overhaul bill of its own on a 220-215 vote. After the vote Saturday night, senators will leave for a Thanksgiving recess. Upon their return, assuming Democrats prevail on the vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.

Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions before a final package could land on Mr. Obama's desk.

The bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.

Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.

Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.

The Senate bill was written by Reid in private negotiations with White House officials, combining elements of two committee-passed bills and making additional changes with an eye to getting the necessary 60 votes.

Along the way, Reid sweetened the pot for individual senators, adding federal funds for Louisiana and agreeing to support an amendment written by Sen. Ron Wyden, D-Ore., that would expand eligibility for the purchasing exchanges.