Lawmakers set to make health bill changes

Bracing for a lengthy debate that has been rambunctious since day one, lawmakers are preparing dozens of additional changes to Democrats’ health care overhaul legislation.

Everything from the major flashpoints — government-run insurance, Medicare spending and abortion — to lesser-known topics such as hospital reimbursements and an in-home insurance plan are likely to face intense scrutiny on the Senate floor in the form of amendments.

Sens. Susan Collins, Maine Republican, and Joe Lieberman, Connecticut independent, plan to offer amendments to reduce the rate of hospital-acquired infections and change the way the small-business tax credits are structured, according to a Senate aide.

“I’d like to see more of a penalty for [government-backed] reimbursements to hospitals that have high rates of hospital-acquired infections,” Ms. Collins told reporters on Tuesday.

Ms. Collins discussed both issues with White House health care “czar” Nancy-Ann DeParle in her Senate office on Monday, signaling just how closely Democrats are listening to her in hopes of getting bipartisan support for their bill.

Mr. Lieberman is also a swing vote, meaning that his and Ms. Collins’ amendments are likely to get more than a glance from Democratic leaders. He is an independent and caucuses with Democrats but said he would support a Republican filibuster if the legislation contains a public insurance plan at the end of the debate.

Any amendment that significantly changes the legislation could change the dynamic of attracting 60 votes. Changes that pick up the support of some members could come at the cost of others. For instance, if an amendment to remove the public option passes, one or two moderate Republicans could come on board, but it could make liberal Democrats revolt.

The debate over the first two amendments has already been contentious. The Republicans’ first amendment — a proposal to eliminate nearly $500 billion in Medicare cuts — was dubbed a “huge big belly-flop flip-flop” by Senate Majority Leader Harry Reid of Nevada.

Mr. Reid said Sen. John McCain’s amendment was merely “one big earmark to the insurance industry” and not in line with the Arizona Republican and former presidential candidate’s disdain for members of Congress favoring specific companies or industries in legislation.

Democrats say the proposed cuts would merely eliminate waste and fraud and not have an impact on benefits. But Mr. McCain and Republicans say there is no way to make such cuts without reducing seniors’ care.

The Democrats’ first amendment, from Sen. Barbara A. Mikulski of Maryland, was co-sponsored by Sen. Olympia J. Snowe, Maine Republican. It would give the health and human services secretary the authority to require insurers to cover additional preventive screenings for women. Just last month, controversial recommendations to limit screenings sparked worry that the Democrats’ plan would ration care.

The debate is expected to last at least through the end of the year, with dozens of amendments offered by both sides.

Sen. Ben Nelson of Nebraska, one of the Democrats most skeptical of the legislation, said he plans to introduce amendments to insert abortion restrictions, strip the CLASS (Community Living Assistance Services and Supports) Act — a program to fund in-home care for disabled Americans that some say has questionable funding — and “deal” with the public insurance plan.

He declined to say how he plans to address the public plan, but said he prefers a state-based approach and would consider a plan in which states can “opt in” instead of opt out, as the bill currently is written.

Mr. Nelson said he would have a hard time voting for a health bill that doesn’t have abortion restrictions similar to what the House passed last month. Their plan, with an amendment from Rep. Bart Stupak, Michigan Democrat, would prohibit patients on the public insurance plan from obtaining abortions without separate insurance. It sparked a firestorm from supporters of abortion rights who said the language went too far.

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