Senate Dems’ challenge _ find a health care formula that will win backing of moderates

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Senate moderates hold key to health care’s fate

WASHINGTON — The fate of President Barack Obama’s health care overhaul is in the hands of a dozen or so political moderates in the Senate. What makes it unpredictable is that they don’t agree on two critical issues — abortion and whether to allow the government to sell insurance in competition with private insurers.

Floor debate continued Friday, and it was hard to see how Majority Leader Harry Reid, D-Nev., puts together 60 votes to overcome a Republican filibuster and get a final bill off the floor. On abortion coverage and a government health insurance plan, the moderates were lining up in different places. Reid has 60 senators in the Democratic caucus, and nary a vote to spare.

The Senate’s No. 2 Democrat, Richard Durbin of Illinois, was unfazed.

“We feel like we’re moving to the point where soon we can talk about an endgame, where we have an agreement that can bring together 60 votes,” Durbin told reporters. “But we’re not there yet.”

Even a rare feel-good moment in a generally sour debate illustrated the Democrats’ challenge.

Calling themselves the “tripartisan” group, Independent Sen. Joe Lieberman of Connecticut, Maine Republican Susan Collins and Pennsylvania Democrat Arlen Specter came together to praise the goals of Reid’s bill and outline an amendment that would give patients better information about the quality of their doctors and insurance plans, and crack down on hospitals where poor sanitation leads to high rates of avoidable infections.

Collins and fellow Maine Sen. Olympia Snowe are two Republicans who may yet be persuaded to vote for the Democratic bill.

But on the issue of a government-run health plan to compete with private insurers, Lieberman and Collins said they part ways with Reid. Rejecting a compromise that would allow states to opt out of the government plan, Lieberman is threatening to filibuster the bill.

“This is a good bill in many ways,” Lieberman said, noting that it begins to control costs, extends coverage to millions of uninsured and bars insurance industry practices like denying coverage to people with pre-existing medical conditions.

“To me the public option, so-called — which is really a government-created and government-run insurance company — doesn’t support any of those purposes,” Lieberman said.

“Senator Lieberman said it very well,” Collins added, saying she has yet to see any compromise that would be worth supporting.

Difficult as it is to find common ground on government coverage, it gets nearly impossible when abortion is added to the mix — particularly since the moderates line up differently.

Collins, for example, says she’s satisfied with Reid’s effort to ensure that health plans operating in a new insurance marketplace do not use government funds for abortions, except in cases of rape, incest, or to save the life of the mother.

But another moderate — Nebraska Democrat Ben Nelson — is threatening to filibuster the bill unless the Senate adopts strict prohibitions accepted by the House. On the public plan, Collins and Nelson are on the same side. But they disagree vehemently on abortion coverage.

Nelson’s anti-abortion amendment is expected to come up for a vote next week, and Catholic bishops are using the weekend to mobilize support for it.

If Nelson loses — as he well may — the dominoes will start falling for Reid. Without Nelson, the Democratic leader will be forced to seek support from either Collins or Snowe to keep the bill moving.

“At the end of the day we need Senator Nelson’s vote,” Durbin said. “We still don’t have a promise of a vote from the Republican side, so we would need his vote.” Democratic leaders are working on an overarching “manager’s amendment” that they hope can resolve the differences.

The big losers could be Democratic liberals. They back a strong public plan and oppose tighter restrictions on abortion coverage. Some are threatening to walk away if Reid makes too many concessions. He needs their votes as well.

“Abortion and public option are really the major obstacles at this point,” said Durbin, adding that leaders were working toward an abortion compromise that could satisfy Nelson.

That would still leave the issue of a government insurance plan.

With the knowledge of Reid and the White House, Sen. Tom Carper, D-Del., along with Democratic Sens. Mark Begich of Alaska and Mark Warner of Virginia, are taking the lead in crafting a compromise. The idea remains a work in progress, but the three presented the outlines Thursday evening in a private meeting with Nelson, Lieberman and about a half-dozen other moderates.

As described by Carper and Begich, the compromise would put a nonprofit insurance option in place only in states that didn’t meet certain criteria for affordability and access. Instead of being controlled by the government, the plan could be run by a nonprofit board, and any initial government startup money would be repaid.

Associated Press writers Erica Werner and David Espo contributed to this report.