As Congress considers an overhaul of the nation's health care system, pressure is mounting on a small circle of Senate moderates who helped advance President Obama's economic stimulus this year.
Centrists in both parties, including Sen. Susan Collins, R-Maine, and Sen. Ben Nelson, D-Neb. — both of whom played a critical role in shaping the stimulus — are being courted by interest groups and the White House as lawmakers seek a way to provide health care to 46 million uninsured people.
"On the Senate side, there is more outreach … to Republicans than was the case during the early days of the stimulus," said Collins, who said she has heard frequently from the administration and Sen. Max Baucus, D-Mont., a key architect of the health care effort. "It's in everyone's interest to try to advance a bipartisan bill."
Baucus, chairman of the Senate Finance Committee, said he hopes to have a draft bill this month. A separate proposal by Sen. Edward Kennedy, D-Mass., began circulating last week. Lawmakers have negotiated for weeks over controversial provisions such as a government-run insurance program and how to pay for the more than $1 trillion the proposal may cost.
Democrats, including Baucus, say they want Republican support, but the effort has been strained as the White House has pushed aggressively for a government plan.
Nine Republicans on the Finance Committee sent a letter to Obama, released Monday, arguing that such a plan would lead to "a federal government takeover of our health care system."
The only GOP member of the committee who did not sign the letter is a moderate: Sen. Olympia Snowe of Maine.
If Democrats want Republican support, they will probably need 60 votes, the threshold required to stop filibusters and proceed to a final vote. Democrats can count on 59 votes, but it is not clear whether all Democrats will vote for whatever proposal emerges.
"I assume they'll place a great emphasis on trying to get to 60 votes, in which case moderate support will be very important," said Sen. Evan Bayh, D-Ind., who formed a coalition of centrist Democratic senators in March. "That's the ideal situation."
Interest groups have been airing advertisements in states represented by moderates, including Maine, Nebraska, Indiana and Pennsylvania, where Sen. Arlen Specter abandoned Republicans to become a Democrat in April.
MoveOn.org, a group that raises money and organizes for liberal causes, used a series of radio ads to seek support for the government-run insurance option. Those ads ran in six states, including Maine and Oregon.
"We made a conscious decision to put that argument in front of senators who have a real role to play in securing this public health care option," said Ilyse Hogue, a MoveOn spokeswoman.
One group, the Consumers Union, knocks on doors in Maine to talk with constituents about health care.
Conservatives have also focused on centrists. The Americans for Prosperity Foundation has aired ads in Indiana, Arkansas, Montana and Nebraska, among other states, likening Democratic proposals to state-run health care in Canada. "We're bringing education to … where the education is going to matter," spokeswoman Amy Menefee said.
Approval of the $787 billion economic stimulus bill in February hinged on the Senate's ability to find 60 votes. Three Republican senators, Collins, Specter and Snowe, voted for the bill.
If bipartisanship fails, moderates may not be as important because Democrats can rely on a tactic known as reconciliation. If used, supporters could pass a bill with 51 votes, meaning Republicans might not be needed. Baucus and other Democrats have said they would prefer to find a compromise.
"The moderates will be very important," said Richard Kirsch, national campaign manager for Health Care for America Now, which has run ads in several states represented by moderates. But, he added, Democrats have significantly more leverage because of the reconciliation option.
Reconciliation, though, could be thorny. Democrats would have to secure fewer votes but "there's a huge, capital letter B-U-T," said Robert Dove, a former Senate parliamentarian. The minority party can put up roadblocks, some of which require 60 votes to overcome.