WASHINGTON — The healthcare debate in Congress will enter a more intensive phase now that the Senate Finance Committee has nearly completed its far-reaching overhaul legislation. The question still dividing Democrats is whether the bill is far-reaching enough.
The finance panel finished considering amendments in the early morning hours Friday, after approving ones to shore up the Democrats' position on a politically explosive issue: making sure that the bill does not saddle middle-class families with insurance costs they cannot afford.
Otherwise, the panel left largely intact the middle-of-the-road bill sponsored by Chairman Max Baucus (D-Mont.), despite attacks from the left and right. The panel's final vote on the bill is to come early next week, after its cost and impact are assessed by the Congressional Budget Office.
Attention already is shifting to the Senate Democratic leadership and the White House as they begin to referee differences between the Baucus bill and a more liberal one by the chamber's health committee before taking it to the Senate floor.
Full debate is expected to begin in mid-October and stretch over weeks. Republicans are planning an onslaught of amendments, and the 58 Democrats and two independents will have to stick together to break any filibuster attempt.
But Democrats are divided on a key issue that liberals promise will be joined anew by the full Senate: whether to overturn the finance committee recommendation and set up a government-run insurance program to compete with private plans.
"With some work and some compromise, we can get the 60 votes on the floor of the Senate -- which we don't have now, I admit that," said Sen. Charles E. Schumer (D-N.Y.), a leading public-option proponent on the finance committee.
That panel's bill was drafted to stay within President Obama's target price tag of $900 billion over 10 years. It also meets Obama's demand for offsetting revenue increases or spending cuts so that the healthcare overhaul does not add to the federal deficit.
The Congressional Budget Office will analyze the bill, as amended by the committee, to see if it still meets that target -- a key factor for fiscally conservative Democrats on the committee. If the bill doesn't meet that test, the panel will probably revise it next week before taking a final vote. Because Democrats hold a 13-10 majority, the committee is all but certain to approve the bill.
Sen. Olympia J. Snowe of Maine, the only Republican open to backing the bill, said that she was undecided but that her vote in committee might not presage her final Senate vote.
"This is the first step on a very long journey," she said.
During the finance committee debate, Republicans did not succeed in making any major changes in the bill. But they honed lines of attack that could be politically and legislatively damaging to Democrats in the wider audience commanded by the full Senate: claims that it would hurt the elderly and raise taxes on the middle class.
The bill aims to reduce the ranks of the uninsured and underinsured, by expanding eligibility for Medicaid and making it harder for insurers to cut off benefits, deny coverage, or discriminate against women in setting premiums. It would require most individuals to buy health insurance or face an excise tax; provide more than $400 billion in subsidies for those who cannot afford the premiums; and penalize employers that do not offer coverage to workers. It would set up a new marketplace, or "exchange," in which small businesses and individuals who do not have coverage through their employers could buy affordable insurance.
The bill also encourages the establishment of nonprofit insurance co-ops where consumers could band together to get group rates. That was included in lieu of the government option that was approved by the more liberal Senate health committee. Two efforts to add a public option were defeated in the finance committee by a coalition of Republicans and centrist Democrats.
The cost of the bill would be offset, in part, by curbing fees paid to doctors and hospitals under Medicare and by imposing penalties on individuals who do not buy health insurance. Those provisions were targeted by Republicans, who portrayed the bill as an attack on the elderly and a violation of Obama's campaign promise to not raise taxes on anyone earning less than $250,000 a year.