Health amendments stack up

Senators prepared to cast their first votes today on health-care legislation, but even as partisan divisions hardened and contentious amendments stacked up, Democrats increasingly expressed optimism that they would succeed in passing a bill before Christmas.

The initial amendments offered illustrated the legislation's vast scope and lingering vulnerabilities. The first, cosponsored by Sens. Barbara A. Mikulski (D., Md.) and Olympia J. Snowe (R., Maine), would increase preventive health care for women at a 10-year cost of $940 million. One aim of the measure is to blunt concerns raised last month when an independent commission recommended that women undergo mammograms less frequently.

The second amendment, sponsored by Sen. John McCain (R., Ariz.), would strip out the bill's primary revenue source, nearly $500 billion in Medicare cost savings. Although AARP and other seniors' groups have argued otherwise, Republicans are attacking the cuts as a threat to current benefits that could eventually shorten lives.

McCain told reporters, "They've paid all their working lives into the Medicare trust fund, and now they're in danger of having $483 billion cut out of it, which would eventually lead to rationing of health care for seniors in order to fund a new, government-run health-care system in America."

Other flash points expected to reach the floor in the form of amendments would target bill provisions related to abortion and illegal immigrants.

Senate Majority Leader Harry Reid (D., Nev.) said debate could continue through the weekend.

"I want people to feel that they've had an opportunity to understand the bill, offer whatever amendments they think will improve it," he said.

Republicans are targeting key sections of the bill, including the nearly $400 billion in tax increases that would finance its 10-year, $848 billion cost. GOP lawmakers also are expected to propose significant changes to medical-malpractice laws.

To manage the expected deluge of Democratic amendments, Reid and other leaders are urging their colleagues to focus only on their top priorities for floor consideration.

One pending proposal would increase federal funding for residency training to relieve the cost burden on large teaching hospitals in states such as Pennsylvania, Florida, California, Illinois, and New York.

Sponsored by Sen. Charles E. Schumer (D., N.Y.), the measure would provide $2 billion in additional funding over 10 years to create an extra 2,000 residency slots nationwide.

Another group of Senate Democrats, including Sen. Bob Casey of Pennsylvania, is pushing improvements to the State Children's Health Insurance Program. And a group of moderates, including Sen. Tom Carper of Delaware, is crafting language to strengthen cost-cutting programs.

Centrist Democrats, who are likely to decide the bill's fate, appeared reassured by a Congressional Budget Office report rejecting insurance-industry assertions that the Senate measure would add thousands of dollars to the average family's insurance bill.

The CBO found that Reid's package would leave premiums unchanged or slightly lower for the vast majority of Americans who get coverage through their jobs.

A key moderate, Sen. Ben Nelson (D., Neb.), said he remained concerned about people who would face higher premiums. But he said he was more immediately focused on other problems in the package, including whether federal funds would directly or indirectly subsidize abortions.

Nelson said he would introduce an amendment similar to one the House adopted, barring the public plan that the bill would include from providing abortion services, while barring people who receive federal subsidies from using that money to buy insurance that includes abortion coverage.

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