Health bill doubters remain in spotlight

All eyes were on a moderate Republican with continued misgivings about affordability, a fiscally conservative Democrat worried about the deficit, and two liberals who wish the bill included a so-called “public option” as a health care overhaul bill cleared a major hurdle Tuesday.

All four Senate Finance Committee members voted in favor of the bill, but their concerns highlight the fault lines taking shape as the full chamber prepares to tackle health care reform.

Sen. Olympia J. Snowe of Maine was the only member to cross party lines in Tuesday’s vote, though the Republican was quick to issue the caveat that her support did not guarantee a vote on the final package.

“Is this bill all that I would want? Far from it,” Mrs. Snowe said of Finance Committee Chairman Max Baucus’ $829 billion plan, which was approved by a vote of 14 to 9. “There are many, many miles to go.”

The Finance bill would extend health care coverage to millions of the uninsured, largely by expanding eligibility for Medicaid as well as by providing tax credits for individuals and families to satisfy a mandate requiring Americans to have insurance. Instead of a public option, the bill would create a network of nonprofit insurance cooperatives.

Mrs. Snowe cited numerous reservations with the legislation, chief among them affordability and the potential for “vast governmental bureaucracies.” She also said she was apprehensive of how the Finance bill could change as it gets combined with a more liberal version from the Senate health committee, which includes a public option.

Of course, a big change is just what some Democratic members of the Finance Committee said they were counting on when they cast a vote in favor of the bill. Sen. John D. Rockefeller IV of West Virginia, who publicly was undecided prior to the vote, long bemoaned the absence of a government-run plan that he said would foster competition with private insurers.

“It’s regrettable to say so, but I believe the bill before us still falls short of what people need and what people expect from us,” Mr. Rockefeller said. “This bill does not go far enough to protect vulnerable populations.”

Like Mr. Rockefeller, Sen. Ron Wyden, Oregon Democrat, questioned whether the Finance bill would produce sufficient competition that would lower costs, and he said consumers would still have only a few choices.

At the other end of the spectrum, Sen. Blanche Lincoln, Arkansas Democrat, said her constituents are frightened by skyrocketing deficits and skeptical of lengthy health care bills. Mrs. Lincoln said she would like the bill’s legislative language as well as the full cost estimate posted online for the public before a full Senate vote.

Americans are “alarmed about big bills that are difficult for them to understand, and they need to have time to look at them, just as we do, to ensure we get it right,” she said.

Political operatives of both stripes pounced on the highly anticipated vote. The Senate Republican campaign arm took aim at Mrs. Lincoln for voting to “increase health care costs for American families.” Meanwhile, the Democratic campaign organization blasted Republican Sen. Charles E. Grassley of Iowa for voting to “kowtow” to his party’s right wing, aligning himself with insurance companies.