WASHINGTON — Moderate Senate Democrats threatened on 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 portends a rowdy floor debate next month on legislation that would extend coverage to roughly 31 million Americans. Republicans have already made clear they aren't backing the bill.
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 centrist Sen. Ben Nelson, D-Neb.
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 about the measure. They warned that they might not support the final bill.
A key sticking point is a provision that would allow Americans to buy a federally 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," Lieberman said.
The sway held by such a small group of senators has annoyed their more-liberal colleagues, who could vote against a final bill if they believe it has become too watered-down.
Sherrod Brown, D-Ohio, said he didn't think rank-and-file Democrats would feel compelled to go that far. At the same time, he warned party 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," Brown said.
The Senate bill would require most Americans to carry insurance; it would 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 be subject to 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.
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 on a near party-line vote of 220-215.
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 Obama and lawmakers can shift their attention to the economy.
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," he said.
Sen. Chuck Schumer, D-N.Y., 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 include the provision, all 58 Democrats and independent Sens. Lieberman and Bernie Sanders of Vermont...
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