Dems up pressure on health bill’s holdouts

The road to health care reform, it seems, passes through Nebraska, Arkansas and Louisiana. And maybe Maine.

Democratic leaders don’t yet have the 60 votes required to start formal floor debate on the health care reform bill, but hope that pledges to lower the deficit, improvements to affordability and, in one case, a home-state sweetener, could seal the deal.

All but three Democrats - Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary L. Landrieu of Louisiana - are expected to support the procedural vote required to start debate on the bill that Majority Leader Harry Reid of Nevada introduced this week. The holdouts, all moderates, want a chance to review the 2,074-page bill as debate is scheduled to begin Friday and the first votes are planned for Saturday night.

In case the three don’t budge, Democratic leaders are also pursuing moderate Republicans, though at least one said the conversations haven’t been backed up with any changes to the legislation.

Sen. Olympia J. Snowe, a moderate Republican and frequently a bipartisan legislator, said she won’t support the bill because it doesn’t do enough to make insurance affordable and protect small businesses. Ms. Landrieu has shared similar concerns with reporters.

But Mr. Reid has addressed at least one of Ms. Landrieu’s interests with a $100 million provision in the bill he crafted behind closed doors.

The measure directs the federal government to pay a larger share of Medicaid costs in Louisiana to cover expenses that the state picked up as a result of demographic changes after Hurricane Katrina, according to a Democratic aide who said Ms. Landrieu had been working to get the new funding for months.

The first vote - normally a procedural formality to start debate - is going to be far more important on the health care legislation as Democrats have to come up with all 60 votes themselves. Republicans have pegged the procedural measure as a vote on the merits of the legislation in an attempt to up the ante. They say that the legislation is far too flawed to be repaired through the amendment process, so they plan to vote against starting debate.

Mr. Reid’s bill would allow the government to sell insurance, require nearly all Americans to purchase coverage and tighten insurance industry regulations. It would be funded through cuts to the Medicare program and a series of new taxes on upper-income payrolls, high-valued insurance plans and cosmetic surgeries.

Republicans have balked at the Medicare cuts and argue that the bill would drive up insurance premiums. Abortion, immigration, deficit impact and the government’s role in health care are all expected to be debated in the coming weeks.

The moderate Democrats and Republicans say they are being seriously courted by leaders to support the measure.

“I have leverage now. I am using it to the best of my ability. I am going to use my leverage on the floor just like every senator will be able to,” Ms. Landrieu said. “We have to be respectful of our honest difference of views between the liberals, the moderates and the more conservative and so far so good.”

Ms. Landrieu said Mr. Reid’s bill addressed some of her concerns, but not all of them. She’s still worried about whether insurance - which nearly all Americans would be required to obtain under the bill - would be affordable.

Mr. Reid, when asked how he would come up with the 60 votes, said he has tried courting Ms. Snowe and Sen. Susan Collins, both Maine Republicans. Ms. Snowe said Thursday that Mr. Reid has tried to get her vote but the conversations haven’t been productive.

“The conversation has to translate into something specific and that’s the issue and that hasn’t happened,” Ms. Snowe said.

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