Sweeteners for senators helped seal deal to advance bill

As Democrats secured the 60 votes they need to pass the Senate's health reform package, new details emerged on the measure's costs and provisions.

The last Democratic holdout--Sen. Ben Nelson of Nebraska--said Saturday that he was throwing his support behind the legislation. That would give the Democrats the 60 votes they need to overcome a filibuster and push the bill to final passage.

“I truly believe this legislation will stand the test of time and will be noted as one of the major reforms of the 21st century,'' Nelson said.

But Nelson, who had earlier rejected the measure because of concerns over abortion coverage, was cautious in his support. He said that under terms of the agreement, reached between Senate leaders and the White House, he could withdraw his support “if material changes” are made when the bill is melded with a more liberal one in the House.

Other details behind Nelson's deal were also made public. For instance, the federal government is expected to foot Nebraska's share of an expansion of the Medicaid program while other states are on the hook to pay for their own.

Another holdout senator, independent Bernie Sanders of Vermont, won what will become a $14 billion investment over 10 years for community health centers. The measure is expected to provide primary care for 25 million more Americans and reduce costs by lowering the rate of emergency room use. The provision would also provide loan repayments and scholarships for primary-care physicians, dentists, nurses, mental health professionals and others.

Meanwhile, the Congressional Budget Office said that the revised health reform package would cost $871 billion over the next decade, roughly $22 billion more than the original legislation, and increase health insurance coverage to 94% of Americans.

Additionally, the CBO said that the amended reform bill would decrease the federal deficit by $130 billion over 10 years.

The price tag comes in under the $900 billion ceiling urged by the Obama administration and played a role in attracting Democrats who were gun-shy over the cost of reform.

In a concession to Nelson's objections, the deal more firmly separates federal funding from health plans that provide abortion services.

Terms of the deal were set out in a 383-page amendment crafted by Senate Majority Leader Harry Reid (D-Nev.), which greatly refigures parts of the underlying legislative package.

Another change strips a measure from the original package that would have erased a scheduled 21% physician pay cut under Medicare with a 0.5% increase in 2010.

“The doctors' fix was done because the doctors felt that was the best way to move forward,” Reid told reporters.

Reid said that the fix should be a permanent one. The original Senate package included a measure that would have replaced a 21% pay cut, which starts in 2010, with a one-year, 0.5% increase.

“They didn't want that,” he said, referring to the short-term fix. “They're entitled to more than that and we agree.”

Reid pledged that the Senate would work on the physician pay fix starting in January. Earlier in the day, the Senate approved legislation that would stave off the pay cuts until late February.

The move apparently took the physician community by surprise and could stunt support for the legislation from groups like the American Medical Association, which has been tepid in its backing of the bill.

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