Senate divided as health debate begins

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By Jennifer Haberkorn

Senate leaders on Tuesday are scheduled to take up the Democrats' health care reform bill in what's expected to be a raucous debate through at least the end of the year. The bill would establish a government-run insurance program, require nearly all Americans to obtain insurance, issue tax credits to help purchase coverage and fine some employers that don't provide it.

Nearly all Republicans are unequivocally opposed to the legislation, putting the burden of finding 60 votes on Democrats, who hope to pick up a handful of Republicans.

The public insurance plan is going to play a significant role in the debate, despite the fact that the Congressional Budget Office estimated that only about 6 million people would end up on the plan. It has become the most significant lightning rod - many Democrats deem it necessary to drive down costs, while Republicans say it would give government too large a role in health care. Other sticking points are likely to be the cost and the impact on the deficit; funding for abortion; and coverage of illegal immigrants.

In the Senate, where the bill can't pass without 60 votes, every lawmaker will matter. But here are the people to watch out for:

The liberals: Sens. Roland W. Burris, Sherrod Brown, John D. Rockefeller IV, Bernard Sanders and Sheldon Whitehouse. Liberal Democrats argue that the public insurance plan included in the bill is the only way to effectively hold insurance companies' feet to the fire and lower health care costs for all Americans. Mr. Burris, the Illinois Democrat who occupies President Obama's former seat, is the only lawmaker who has publicly insisted he won't vote for a bill without a public option. But clearly other liberals have thought about it.

"I strongly suspect that there are a number of senators, including myself, who would not support final passage without a strong public option," Mr. Sanders, a Vermont independent who caucuses with Democrats, said last week.

If Democratic leaders determine they don't have the votes to pass the bill with the public option - a serious possibility - the provision could be removed. If so, liberals would find themselves in a tough spot between voting for a weaker bill and voting against their one shot at trying to reform the nation's health care system.

The swing votes: Sens. Ben Nelson, Mary L. Landrieu and Blanche Lincoln. All of these moderate Democrats are leery of the public insurance plan as well as the cost of the bill and its impact on the deficit. They were the last to commit to voting in favor of starting debate, and all warned that it doesn't mean Democrats can count on their votes in the future. Watch for these moderates to be courted heavily by Democratic leaders.

The repairman: Sen. Thomas R. Carper. The key to a compromise that gets 60 votes could come from this moderate Democrat from Delaware. Mr. Carper has been working on a proposal, which he jokingly calls "the hammer," that would establish a public insurance plan only in states that don't meet certain criteria, such as not enough competition or premiums that are too high. It's similar to the so-called "trigger" option Maine Sen. Olympia J. Snowe, a Republican, has floated. Her support would likely do a lot to bring other moderates on board. Sen. Charles E. Schumer, New York Democrat, a liberal, has worked with Mr. Carper on the plan.

The wild card: Sen. Joe Lieberman. A Connecticut independent who caucuses with Democrats, Mr. Lieberman isn't afraid to buck Democrats on important measures. He was one of the first in the caucus to pledge to help Republicans filibuster the health care bill if, at the end of debate, it still has a public insurance plan.

"I'm at a point in my public service career that I'm just going to do what I think is right and makes sense," Mr. Lieberman told reporters last month when explaining why he'd support a filibuster against Democrats' wishes.

The moderate Republicans: Mrs. Snowe and Sen. Susan Collins. Senate Majority Leader Harry Reid, Nevada Democrat, has said that he's been courting the two Maine senators, who in the past have worked with Democrats. Mrs. Snowe said Mr. Reid has reached out to her, but the conversation hasn't led to any constructive changes to the legislation yet. But expect the pressure on the Maine senators to increase if the Democratic swing votes don't support the bill.

Republicans: All of the 40 minority lawmakers have said there is no way they can support the Democrats' bill unless drastic changes are made, with some Republicans looking for more changes than others. They argue that the bill would cut Medicare benefits to seniors, raise taxes and increase premiums. Look for them to offer dozens of amendments to the legislation in the coming weeks.

The quarterback: Mr. Reid. Fellow Democrats have hailed Mr. Reid's skill in crafting the health care bill and his ability to count votes, dubbing him their quarterback. Now that Mr. Reid, who is facing a tough re-election bid next year, owns this bill, expect him to work to find the elusive compromise that leads to 60 "yes" votes. He's also going to be responsible for keeping the process on schedule, with a goal of passage by Christmas break, blocking Republicans' attempts to slow down the process.

The wingmen: Sens. Max Baucus, Christopher J. Dodd and Tom Harkin. These Democrats shepherded their health care reform bills through their respective committees - Mr. Baucus is the Finance Committee chairman, and Mr. Dodd was acting chairman of the Health, Education, Labor and Pensions Committee when it passed the bill. He then handed the gavel to Mr. Harkin. Watch for them to play roles in helping Mr. Reid reach 60 votes. Mr. Baucus was viewed by moderates as their negotiator with Mr. Reid, while liberals counted on Mr. Dodd.