WASHINGTON, Nov. 19, 2009— -- The battle to pass health care legislation has entered one of its final and most difficult phases.
Late Wednesday evening, Senate Majority Leader Harry Reid, D-Nev., unveiled the 2,074-page bill that will be debated in the Senate -- one of the biggest and most expensive bills to ever come to Congress.
On Saturday, the Senate will begin debate on the bill around 10 a.m. ET, and call for a procedural test vote around 8 p.m. The cloture on the motion to proceed will require 60 votes in order to end debate on the bill.
Reid will need all party members to support the bill if he wants to break the first Republican attempt at a filibuster. And what does it take to get a wavering senator to vote for health care legislation?
Here's a case study: On page 432 of the Senate bill, there is a section increasing federal Medicaid subsidies for "certain states recovering from a major disaster."
The section spends two pages defining which states would qualify, saying, among other things, that it would be states that "during the preceding 7 fiscal years" have been declared a "major disaster area."
ABC News has been told the section applies to exactly one state: Louisiana, the home of moderate Democratic Sen. Mary Landrieu, who has been playing hard to get on the health care bill.
In other words, the bill spends two pages describing would could be written with a single world: Louisiana.
Reid, who drafted the bill, cannot pass it without Landrieu's support.
How much does it cost? According to the Congressional Budget Office: $100 million.
The full bill is available here.
The Senate health care bill, put together solely by Democrats, would cost $848 billion over 10 years and cover 31 million Americans who are uninsured.
The plan would cut the federal deficit by $130 billion in its first decade, more than any other bill, according to estimates by the non-partisan CBO. It would cut the budget deficit by as much as $650 billion in the second decade.
Ninety-four percent of Americans would have insurance under the legislation, which would be paid for with a menu of taxes on the wealthy and on high-cost, all-inclusive insurance plans that some people say drive up overall health care costs, and a new five percent tax on elective surgery. It also would cut spending by nearly $500 million on Medicare.
Under the proposed plan, almost all Americans would be required to have health insurance, or pay a fine -- up to $750 for an individual and $3,000 for a family. The public would be able to choose a government-run insurance plan that would be offered, along with private coverage, in an insurance "exchange."
It would also provide subsidies to households with less than $88,000 income to buy health insurance.
Getting the bill passed will be a tough and controversial battle. Republicans are ready to put their weight behind opposing the plan, and are getting more pointed with their criticisms of the bill.
"It's going to be a holy war," Sen. Orrin Hatch, R-Utah, told The New York Times.
Sen. Tom Coburn, R-Okla., has threatened to use a procedural move that would require Senators to read the entire health care bill before voting for it.
One of the main Republican talking points against the Democrats' health care proposals is that they are each, as Sen. Mitch McConnell, R-Ky., has put it, "another thousand-page, trillion-dollar spending bill."
If Democrats are ultimately able to pass a bill through the Congress, however, which would be unlikely until next year, it would be a melded version of the Senate and House bills and would be closer to 2,000 pages than a 4,000-page amalgam.
But Republicans have taken the two roughly 2,000-page stacks of paper and placed them one on top the other, creating a 4,000-page pedestal of paper on the Senate floor.
Sen. Lamar Alexander, R-Tenn., comfortably put his elbow on the stack while giving a floor speech this morning.
"So we've got, we've got a little reading to do, a little work to do," Alexander said of the bill. "Here is my early verdict in terms of the Thanksgiving season. This is the same turkey that you saw in August and it's not going to taste any better in November. It's not much different than what worried you in August. In fact, it's gotten a little bit worse."
Democratic Leaders Confident About Health Care Legislation
Despite the GOP opposition and skepticism from some Democrats about certain provisions in the bill, Democratic leaders have projected optimism.
Reid today, at a press conference with supporters, said the bill would "save lives, save money and save Medicare."
The legislation "is not just a milestone in a journey of a few months or a few years. We have been working to reform health care since the first half of the last century," Reid added.
On Wednesday, Sen. Tom Harkin, D-Iowa, seemed to have tears in his eyes as Democratic leaders unveiled the bill.
"There's one sign that defines this moment," Harkin said.
"It is like this," added Harkin, flashing a "v". "Its victory, and that's what we're going to have on health care."
President Obama released a statement Wednesday calling the unveiling of Reid's bill a "critical milestone in the health reform effort."
"Our goal has been to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don't, and that lowers costs for families, businesses and governments across the country," the statement read. "I was particularly pleased to see that the Congressional Budget Office has estimated that the bill will reduce the deficit by $127 billion over the next 10 years and as much as $650 billion in the decade following, saving hundreds of billions while extending coverage to 31 million more Americans."
The cost of the Senate legislation is lower than that of the bill passed by the House on Nov. 8, which is expected to cost $1.2 trillion over 10 years. The Senate Democrats' bill also meets Obama's goal of keeping the cost around $900 billion, and achieves more than $1 trillion in cost savings.
The White House and Democratic lawmakers have been working closely for weeks to craft the legislation.
Vice President Joe Biden spent most of the day Wednesday on Capitol Hill, meeting with Reid and working from his own office off the Senate floor.
Moderate Democrats who have expressed their reservations with the broad strokes, including Landrieu, Sen. Blanche Lincoln of Arkansas and Sen. Ben Nelson of Nebraska, also met with Reid.
The cloture vote, expected this Saturday, on whether to even start debating the bill will be the first test of the support for Reid's health care bill. Even Reid is not sure right now if he has all the votes.
Americans Divided Over Health Care
Even as Democrats trudge along with their health care overhaul plan, skepticism amid the U.S. public abounds.
Forty-eight percent of respondents to an ABC News/Washington Post poll released Tuesday said they were in favor of health care overhaul, with 49 percent opposed.
Fifty-four percent of insured Americans said it will increase their own costs. Among all respondents, 56 percent thought it will raise overall costs, six in 10 thought it could shut down many private insurers and 61 percent opposed covering abortions in federally supported plans.
House Democrats narrowly passed their version of health care legislation Nov. 8. Only one Republican joined in the vote and the minority party was nearly unanimous in its opposition. Even 39 Democrats opposed the bill, which would cost $1.2 trillion in the next 10 years.
Democrats are deeply divided on the issue of abortion. Some voted against the House bill because it contained an amendment by Rep. Bart Stupak, D-Mich., that would not only cut federal funding for abortion-related activities, it would also limit access to abortions for people who would receive federal subsidies and would have to buy insurance through a health insurance exchange.
Some Democratic senators, such as Nelson, have said they want to see a similar proposal in their bill.
But other Democrats are outraged that this health care bill is focusing on abortion.
"What happened is after the Stupak amendment passed, people really realized it was an unprecedented restriction on a woman's right to choose," Rep. Diana DeGette, D-Colo., said on "Top Line" Tuesday. "So now everybody's sort of taking a deep breath and saying, 'You know, we really don't want to stop people from buying full reproductive care with their own private money.' I think he won't have the votes when people explain to ... those members exactly what the Stupak amendment does."
Stupak disagreed, saying he has ample support for the amendment.
"They're not going to take it out," Stupak said Tuesday on Fox News. "If they do, health care will not move forward. As we expand health care and the federal role in the health care, that prohibition should apply."
Another issue that could threaten Democrats' ability to pass a health care bill through the Senate is public option, a government-run insurance plan that would compete with the private sector. Currently, both the House and Senate versions include that option, but the Senate version gives states the chance to opt out of the public option, if they choose.