Reporting from Washington — After almost a year of maneuvering over policies and politics, the Senate on Monday officially began debate on the landmark legislation to overhaul the nation's healthcare system, but it remained uncertain how long the deliberations would last or how much the bill would change before it comes to a vote.
With Republicans united in opposition and conservative Democrats and the Senate's two independents continuing to express reservations, Majority Leader Harry Reid (D-Nev.) faced a daunting challenge in building the filibuster-proof majority needed for passage.
He promised to keep the Senate working through weekends on the 2,074-page, $849-billion bill in hopes of bringing it to a vote by Christmas and landing it on President Obama's desk for signing before the end of January.
And he sought to remind Democrats that, after investing so much time and political capital in the healthcare issue, the price of failure could be high.
"While each of us may not say 'yes' to each word in this bill as it currently reads, let us at least admit that simply saying 'no' is not enough," said Reid, opening debate on legislation that marks the most ambitious effort in decades to provide near-universal health insurance coverage, slap new regulations on insurance companies and curb the skyrocketing costs of healthcare.
Republicans have considerable power to extend the debate into the new year, and Minority Leader Mitch McConnell (R-Ky.) has indicated that he would like at least six weeks of discussion.
"Kentuckians want to know how spending trillions of dollars we don't have on a plan that raises health insurance premiums and taxes on families and small businesses is good for healthcare or for jobs or for the economy," he said.
But just as debate began, the nonpartisan Congressional Budget Office issued a report challenging Republican claims that the bill would drive up the cost of insurance.
The CBO, which is the arm of Congress that analyzes federal budget and spending proposals, found that under the Senate bill, premiums for most people -- those in group plans provided by their employers -- would remain unchanged or even drop.
The CBO report was produced at the request of Sen. Evan Bayh (D-Ind.) and other wavering centrist Democrats whose support for the bill is crucial to passage.
Bayh said he was reassured by the report's conclusion that people who receive insurance from their employers -- some 83% of the non-elderly population with coverage -- would see little or no difference in their premiums by 2016.
The report found that for the 17% who buy individual policies, premiums could rise by 10% to 13% by 2016.
Those costs would go up mostly because the policies would provide more generous benefits than they do now, the CBO said. And for half of those affected, their own costs would go down because they would receive federal premium subsidies.
Republicans and the insurance industry, however, sought to focus on those consumers the report said were likely to see higher premiums.
"A bill that's being sold as a way to reduce costs actually drives them up," McConnell said.
"This is the latest report to confirm that the current healthcare reform proposal fails to bend the healthcare cost curve," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an industry lobbying organization. .
Noam N. Levey in the Washington bureau contributed to this report.