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Every American would be required to obtain coverage or face annual penalties.
Employers would be fined if they failed to offer affordable coverage and their workers seek subsidies. Firms with more than 50 employees would have to pay a fine equal to $750 for every person on their payroll.
The smallest businesses get additional assistance, including six years of tax credits, starting in 2010 to help businesses with 25 or fewer workers and average wages of less than $50,000 to purchase policies.
New insurance marketplaces — called exchanges — would be set up so people without access to affordable coverage through an employer could buy comprehensive plans.
Workers who couldn't afford employer-offered insurance but earned too much to qualify for a federal subsidy would be permitted to keep their employer's contribution to their coverage and use the money to buy insurance on the exchanges.
Abortion
Tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer the coverage. In plans that accept government subsidies and that cover abortion, policyholders would have to pay for that coverage separately, and the insurance company would have to be keep those premiums in a separate account from any taxpayer money.
Medicaid
Sen. Ben Nelson secured full federal funding for Nebraska to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states will have to begin picking up a portion of the added expense beginning in 2017.
Insurance companies
Nelson won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax, and was able to roll back cuts to health savings accounts.
Key provisions
No public option. Allows private firms for the first time to offer national insurance policies across state lines.
Bans lifetime limits, premium disparity based on health status and sex, and coverage denials based on pre-existing conditions.
Provides grants to state governments to test ways to eliminate medical malpractice lawsuits.
Strengthens cost-containment provisions, expanding the scope of an independent advisory board charged with reining in Medicare costs. The board could make recommendations for Congress, the federal government and the private sector, a change demanded by seniors' groups.
Certain levies increase: Couples making more than $250,000 a year would pay an additional 0.9 percent (up from 0.5 percent originally proposed) in Medicare payroll taxes; people who fail to obtain insurance for even one month would face monthly penalties that by 2016 could add up to as much as $750 a year or 2 percent of a person's income, whichever is greater.
Timeline
The Senate is expected to work its way through a series of procedural motions over the next few days, with a vote on the legislation scheduled Thursday evening of Dec. 24. A conference with the House to produce a final bill would likely extend into January.
-- Compiled from wire service reports
WASHINGTON — Ben Nelson has spent his life negotiating big deals, but never one this big.
The eyes of the nation were fixed on the Nebraska Democrat as he held in his hands the fate of President Barack Obama's top domestic priority — a massive health care system overhaul.
Would he agree to cast the deciding vote to push the bill through the Senate? Or would he send everyone home for Christmas, with nothing to show for many months of legislative wrangling?
For 13 hours Friday, Nelson battled for final concessions in the office of Senate Majority Leader Harry Reid.
On his most important issue — tighter abortion restrictions — Nelson had to win approval from liberal Sen. Barbara Boxer, D-Calif., a fierce champion of abortion rights.
Other liberals, led by New York's tenacious Chuck Schumer, also had to sign off on the final agreement. Top White House officials, such as deputy chief of staff Jim Messina and senior adviser Pete Rouse, reviewed proposals on the table.
Senate staffers shuttled in and out of the room as Nelson traded offers and counteroffers. When Nelson left Reid's office during a break in the negotiations, more than a dozen reporters stampeded down one of the Capitol's sweeping staircases to catch up to him.
Finally, around 10 p.m. Friday, Nelson and Reid sealed the agreement with a handshake.
But Nelson wanted to sleep on it. He needed to inspect the exact language of the compromise.
He also wanted to catch a few hours of rest and prepare the speech that would publicly signal his willingness to back what he described as historic reforms.
Schumer would come away as the classic city slicker impressed by the slow-talking rural colleague.
“He's very good at getting a lot of stuff he needs,” Schumer told The World-Herald. “He's one of the best negotiators I've ever come across.”
Nelson has embraced the role of deal-maker again and again, from his days running an Omaha insurance company to his time as Nebraska governor.
As a senator, he brokered compromises on a major crisis over judicial nominations, President George W. Bush's tax cuts and President Barack Obama's $787 billion stimulus package.
The final abortion language was e-mailed to Nelson's office around midnight. By 7 a.m., Nelson was out the door of his Capitol Hill townhouse and making his way through a rare Washington snowstorm back to the Capitol.
After one last check of the language, Nelson took his place on the Senate floor about 8:30 a.m., ready to claim his moment in the spotlight and deliver the most important speech of his career.
But he was thwarted by Republicans, who have been using every parliamentary tactic at hand to delay consideration of what they view as a fatally flawed bill. The Republicans cut off Nelson's speech by forcing the Senate clerk to read out loud all 383 pages of final revisions to the bill, the “manager's amendment,” or compromise, that was introduced Saturday by Reid.
So Nelson took his remarks out of the chamber and into the corridor, where Senate leaders often meet with the press to discuss the biggest political issues of the day.
Reporters who had been stalking Nelson for more than a week, waiting for him to decide, gathered at the hastily called press conference.
“Change is never easy, but change is what's necessary in America, And that's why I intend to vote for health care reform,” Nelson said.
He cast the bill as historic.
“I truly believe this legislation will stand the test of time and will be noted as one of the major reforms of the 21st century — much like Social Security, Medicare, civil rights legislation were milestones of the 20th century.”
Nelson also sought to highlight the impact of the bill on everyday people, citing heart-wrenching stories of those forced into bankruptcy over medical bills.
“Lives will be saved, and our health care system will once again reflect the better nature of our country,” he said.
At the White House, Obama applauded news of the agreement.
“With today's developments, it now appears that Americans will have the vote they deserve,” Obama said. “There is still much work left to be done and not a lot of time left to do it.”
Inside the beltway and back in the heartland, the health care debate has inflamed passions on both sides throughout most of 2009.
Nelson, in particular, has been under intense pressure. Sign-toting supporters and opponents have staged rallies outside his offices. Advocacy groups have dropped fortunes on advertising wars in Nebraska.
Callers from Nebraska and all over the country have kept his office phone lines red hot, overloading his office's voice mail again and again.
The injection of abortion into the debate only fanned the flames. And prospects for a bill seemed to dim after Nelson drew a firm line in the sand on abortion. He insisted that the Senate had to adopt his amendment to use the same tight restrictions on federal funding for abortion that had been approved by the House.
But his amendment was beaten down, with only 45 of 100 senators supporting it. He then rejected an initial compromise negotiated by Sen. Bob Casey, D-Pa. Nelson said he and his aides stumbled onto the final solution, which he said separates federal funds from abortion services.
Now he must face the consequences of his decision.
It may make him popular at the White House and among some of his fellow Senate Democrats, but his announcement brought swift, scathing denunciations from Republicans — in Washington and in Nebraska.
Nebraska GOP chairman Mark Fahleson declared Nelson's decision “the death knell to his political career in Nebraska.”
In contrast to the charged atmosphere that has surrounded the health care debate, Nelson has sought to maintain a calm demeanor and downplay the pressure he has faced. That was his attitude as he sat on a couch in his Washington office and reflected on his decision. The office was officially closed Saturday and the phones were turned off, silent for the moment.
Was he worried about political consequences back in Nebraska?
Some constituents will certainly be unhappy, he said, but just wait until everyone learns about all the benefits in the bill.
“I think that it will begin to sell itself once it's in place,” Nelson said.
Monday, the phones start ringing again.
Contact the writer:
202-662-7270, joe.morton@owh.com
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