Senate Democratic leaders released a 10-year, $849 billion bill to overhaul the nation's health care system on Wednesday, putting new pressure on three undecided, moderate Democrats whose support is needed to ensure President Obama's chief domestic priority gets to a floor debate.
The bill, which Majority Leader Harry Reid put together, would cut the federal deficit by $127 billion over 10 years and extend coverage to 94 percent of all Americans.
"Many of those who came before us have tried to achieve what we're on the cusp of achieving," said Sen. Christopher J. Dodd, who was acting chairman of the Health, Education, Labor and Pensions Committee when it passed its reform bill in July. "We're going to achieve this goal at long last for the American people."
The bill would enact a government-run insurance plan with a chance for states to opt out and require nearly all Americans to carry private or public insurance. Incentives would be put in place to encourage employers to provide coverage and new regulations would restrict insurance industry practices.
While the House passed its bill relatively quickly, passage in the Senate could be more difficult as the Democrats have no room for error. It's not yet clear whether Senate leaders have the 60 votes required to start formal debate on the legislation.
Mr. Reid needs every Democrat to vote for the procedural measure this weekend to start debate, as all Republicans say the bill is far too flawed. Failure would deliver a painful blow or possibly kill the months-long effort by Democrats to reform the nation's health care system.
All but three Democrats have said they would support it. The holdouts - Sens. Ben Nelson on Nebraska, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas - said they wouldn't make a decision ahead of reviewing the measure Mr. Reid crafted behind closed doors.
After being briefed by Mr. Reid, Ms. Landrieu said she's worried about making insurance affordable and limiting government interference in the health system, Mr. Nelson said his top concern is cost.
Mr. Nelson stressed Wednesday that the procedural vote isn't yet a vote on the merits of the legislation, signaling that he's leaning toward allow debate to start. But Republicans, arguing that the bill is too flawed to be repaired on the floor, have stressed that procedural votes are indeed a nod toward the merit of the bills.
Republicans promised to try to block the legislation over concern that it would cut Medicare spending and raise premiums.
"While Americans have been clear about their opposition to thousand-page bills for new government programs, it's now abundantly clear that Democrats haven't been listening," Minority Leader Mitch McConnell said. "This is yet another trillion-dollar experiment, but it is not what Americans bargained for... Higher premiums, tax increases and Medicare cuts to pay for more government - the American people know that is not reform."
Mr. Reid briefed Democratic lawmakers on the 2,074-page bill late Wednesday night. Many left the meeting saying they were encouraged by what they heard but are waiting to see the legislative details on paper. Cost, immigration, abortion and the government's role in health care are likely to be key sticking points in the coming weeks.
Mr. Reid was expected to formally file the bill on the Senate floor late Wednesday night, setting the stage for the first procedural vote to be held on Saturday, according to a senior Democratic leadership aide who also warned the schedule could change.
"The finish line is really in sight," Mr. Reid said.
Majority Whip Sen. Richard J. Durbin of Illinois said leaders are first focusing on gathering support to pass the procedural vote - to authorize debate to start - and then will work on getting the votes for final passage.
In an attempt to bring the bill in line with what the House passed in its reform bill earlier this month, Mr. Reid's bill would impose new Medicare taxes on individuals reporting incomes over $200,000 and couples earning over $250,000 and tax some of the most expensive insurance policies, with exceptions for people in high-risk jobs.
The new bill reduces a tax on medical device makers - from $38 billion over 10 years to $20 billion - and adds a new tax of 5 percent on elective cosmetic surgeries.
The bill would give the Secretary of the Department of Health and Human Services authority to let the public insurance plan provide coverage for abortions, only if she can ensure that no federal dollars are used to fund the procedure, except in cases of rape, incest or in the interest of the life of the mother. Pro-choice Democrats said the legislation merely upholds existing law, but the provision is likely to be heavily debated in coming weeks.
The $849 billion cost, which a senior Democratic leadership aide attributed to a preliminary Congressional Budget Office analysis, is less than the $900 billion Mr. Obama has called for and far less than the $1.2 trillion cost of the House legislation and could help ease some moderates' concerns over harming the deficit.
The bill's release to Democrats late Wednesday comes amid heavy lobbying on Capitol Hill. Mr. Reid met privately with the three holdouts to talk about how debate on the legislation would proceed and reviewed the details of the bill with Vice President Joe Biden, who was on the Hill meeting with lawmakers Wednesday.
Mr. Reid told the moderates that he's open to an amendment for "trimming back or eliminating the public option," Ms. Landrieu told reporters after the meeting. The public insurance plan has become one of the most controversial elements of health care reform over concern from Republicans and moderates that it would give the government too large a hand in the insurance market and in health decisions.
Ms. Landrieu said her biggest concerns about the bill are the same issues she has raised for months, including concerns that the bill will not lower health care costs and that government-run insurance will undermine the private health insurance market.
Still, neither Mr. Nelson nor Ms. Landrieu said they were ready to commit to supporting the first procedural vote. Ms. Landrieu said the meeting helped her move in that direction, after she was assured the bill's budget score had improved and that the leadership would allow for the amendment to remove the public option.
"I'm probably in neutral right now," Ms. Landrieu said. "This meeting helped."
Ms. Landrieu said that Mr. Reid promised that "there will be a full debate on the floor."
• S.A. Miller, Kara Rowland and Sean Lengell contributed to this report.