Image: Sen. Reid comments on health overhaul
Jose Luis Magana  /  AP
Senate Majority Leader Harry Reid, D-Nev., speaks Saturday after the U.S. Senate voted to begin debate on health care legislation on Capitol Hill in Washington. Sen. Chris Dodd, D-Conn., right, and Sen. Tom Harkin, D-Iowa, look on.
updated 11/23/2009 7:56:07 AM ET 2009-11-23T12:56:07

Moderate Senate Democrats threatened Sunday to scuttle health-care legislation if their demands aren't met, while more liberal members warned their party leaders not to bend.

The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend health care coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill.

Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin debate.

"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Nebraska Democrat.

Nelson and three other moderates — Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas and Connecticut independent Joe Lieberman — agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.

So-called public option
One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.

"I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," said Lieberman.

The sway held by such a small group of senators has annoyed their more liberal colleagues, who could vote against a final bill if it becomes too watered down.

Sen. Sherrod Brown, D-Ohio, said he didn't think rank-and-file Democrats would feel compelled to go that far. At the same time, Brown warned Democratic leaders not to make too many concessions.

"I don't want four Democratic senators dictating to the other 56 of us and to the rest of the country — when the public option has this much support — that (a public option is) not going to be in it," said Brown.

The Senate bill would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.

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Analysts say it will reduce deficit
Congressional budget analysts put the legislation's cost at $979 billion over a decade and say it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.

The House approved its version of the bill earlier this month on a near party-line vote of 220-215.

Video: Sen. Schumer on health bill: ‘It will get done’ Sen. Dick Durbin of Illinois, the No. 2 Democrat in the Senate, said the health care bill must be passed by the end of the year so that President Barack Obama and lawmakers can shift their attention to the economy and improving employment rates.

Such a timeline also would enable Obama to claim victory on a major domestic priority when he delivers his State of the Union speech in January.

But with one-third of Senate seats up for election in 2010, politics will factor heavily into the outcome of the debate on health care.

Sen. Michael Bennet, a junior Democrat who will be seeking his first full term next year in Colorado, where many districts lean conservative, said he would support the health care overhaul even if doing so means losing his seat.

"The thing that our working families need more than anything else is to end these double-digit cost increases that they're having every single year with health insurance," Bennet said.

Enough votes?
Democratic Sen. Chuck Schumer of New York said he believes there are enough votes to include a public insurance option in the bill as long as states are allowed to opt out. To do so, all 58 Democrats and independent Sens. Lieberman and Bernie Sanders of Vermont would have to support it.

Sanders issued a statement Sunday saying, "I strongly suspect that there are a number of senators, including myself, who would not support final passage without a strong public option."

Lieberman and Nelson have said they object to the public option. On Sunday, Nelson said he is open to negotiating the provision; he said he would prefer allowing states to opt into the program, instead of having to remove themselves.

Senate GOP leader Mitch McConnell said the lingering reservations by moderate Democrats indicate that the party's leaders have gone too far. On Saturday, no Republican voted to begin debate on the bill, which they said would cripple industry and drive up costs for the average American.

"I believe there are a number of Democratic senators who do care what the American people think and are not interested in this sort of arrogant approach that everybody sort of shut up and sit down, get out of the way, we know what's best for you," said McConnell.

Brown, Bennet and McConnell appeared on CNN's "State of the Union." Lieberman appeared on NBC's "Meet the Press." Nelson appeared on ABC's "This Week."

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Senate Dems spar over health care bill

  1. Closed captioning of: Senate Dems spar over health care bill

    >>> that in a moment.

    >>> but let us begin with some fallout from this weekend's historic vote to move the debate over health care reform to the floor of the u.s. senate . nbc's savannah guthrie is at the white house this morning. savannah, good morning.

    >> reporter: good morning, matt. with this key vote, democrats are hoping this is the beginning of the end knowing the longer this drags out, the tougher it gets.

    >> the motion is agreed to.

    >> reporter: for democrats, it was a crucial victory. but short-lived. the morning after voting to move the health care debate forward, centrist lawmakers made clear they won't be voting "yes" the next time without big changes. connecticut senator joe lieberman on "meet the press."

    >> i don't think anybody feels this bill, as senator reid put it down, though he made a lot of progress in blending bills together, i don't think anybody thinks that this bill will pass.

    >> as written.

    >> reporter: for lieberman and some red state democrats, the so-called public option, a government-run insurance plan which, under the bill, individual states could opt out of, is a deal breaker.

    >> i don't want a big government , washington-run operation that would undermine the private insurance that 200 million americans now have.

    >> reporter: but without republican support, the president will lead every democrat to stay in line and the liberal wing of the period is pressuring those who defect.

    >> stand with democrats now or we'll find someone who will.

    >> reporter: for saturday's crucial vote, senate majority leader harry reid barely cobbled together a 60-vote coalition.

    >> i just spoke to vicki kennedy. she was of course in tears. she believed that ted is watching us.

    >> i have a feeling maybe.

    >> reporter: now it is a race against the political clock with the president's approval rating dipping below 50% in some polls, it's clear the health care debate is taking a toll. and as an election year looms, senator leaders want to show they are focused on the economy.

    >> we have to finish it in the senate or it is going to be maybe a long lunch break over christmas. we will really get this done. we've spent a year at it but we have to refocus all of our attention on getting back people to work.

    >> reporter: while the senate will begin debate after the thanksgiving holiday, by the way, the president is also expected to make his crucial afghanistan decision after thanksgiving. nbc news has learned the president will have another afghanistan meeting in the situation room today, matt.

    >> savannah, thanks very much. savannah guthrie at the white house . democratic senator chuck schumer of

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