- The Washington Times - Friday, November 20, 2009

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.

Ms. Snowe, the lone Republican to support any of the five versions of the bills coming out of committees, and Ms. Landrieu cite the bill’s impact on small businesses as one of their top concerns. The National Federation of Independent Business said the bill’s new taxes and requirements for businesses will outweigh any positives.

Ms. Lincoln said she wants to read the entire bill over the next two days before she makes her decision.

“I’ve hopefully got the time I think I do,” Ms. Lincoln said. “I’ll be able to finish up looking at the bill and figuring out what are the positive sides of it and what are the down sides, realizing what my opportunity is going to be to make any changes that I feel are going to be important.”

Ms. Lincoln is the only one of the three who is up for re-election next year and is facing a difficult race in a state where the public insurance plan isn’t popular.

A Zogby International poll released Thursday found that in an initial matchup against a potential Republican opponent, state Sen. Gilbert Baker, Ms. Lincoln held a lead of 41 percent to 39 percent.

When asked how voters would feel if Ms. Lincoln voted in favor of the health care bill, her support slipped to 37 percent to 49 percent.

Nearly half of voters responding to the poll - 48 percent - said they would be less likely to back Ms. Lincoln’s re-election if she supported the bill.

The moderates say they are not working as a group - merely keeping one another informed about their negotiations.

“We all have concerns. That’s what the process is about, trying to waylay any concerns you have by making a few changes,” Ms. Lincoln said.

S.A. Miller contributed to this report.

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