WASHINGTON, Dec. 19, 2009 -- Senate Democratic leaders inched closer to attaining their goal of passing a health care bill by Christmas as Ben Nelson, the Nebraska senator who had been skeptical of the bill, jumped on board, winning major concessions for his state, and the Congressional Budget Office released an optimistic cost estimate of the legislation.
The Senate health care bill will reduce the deficit by $132 billion over the next 10 years and will cost $871 billion over the same time period, according to the CBO report released today. The revised health care bill would expand coverage to about 94 percent of eligible Americans under age 65, excluding illegal immigrants.
"With today's developments, it now appears that the American people will have the vote they deserve on genuine reform that offers security to those who have health insurance and affordable options to those for do not," the president told reporters today. "Because it's paid for and gets rid of waste and inefficiency in our health care system this will be the largest deficit reduction plan in over a decade."
The analysis comes after weeks of speculation over what the health care legislation, crafted under the leadership of Majority Leader Sen. Harry Reid, would entail.
The Nevada senator had been mum on the amendments included in the bill, while at the same time trying to woo skeptical lawmakers such as Nelson, who had expressed reservations about the proposals in the bill and whose amendment to inject tougher language restricting federal funding for abortion was struck down on Dec. 8.
The change that would have the biggest impact on the budget, according to the nonpartisan CBO, would be expanding eligibility for a small business tax credit: There will be a $12 billion increase in such credits, beginning in 2010.
Cost cuts will also come from increasing penalties on certain uninsured people, taking out provisions that would increase payment rates for physicians under Medicare and increasing the payroll tax by 0.9 percent on individuals who make more than $200,000 per year and couples who make more than $250,000.
A compromise was also struck with Nelson to limit the availability of abortions in insurance sold in the exchange to be implemented in the new program. At the same time, he would also get millions in Medicaid funds for Nebraska, which boasts a heavy insurance and anti-abortion lobby.
"The bill also includes provisions Nelson won in negotiations shielding Nebraska from an unfunded mandate and new national protections barring public funding of abortion," said a statement issued by Nelson's office.
End for Senate Health Care Bill in Sight?
Current law prohibits federal funding from being used for abortion, but Nelson and several Republicans wanted to take the language further. Nelson's office today said the new provisions would ensure that no public funds go toward abortion services, mandate that every state provide an insurance plan that does not cover abortion and gives each state the right to pass a law barring insurance coverage for abortion within state borders.
"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters today. "But I would not have voted for this bill without these provisions."
The move upset some anti-abortion lawmakers such as Rep. Bart Stupak, D-Mich., who this week told ABC News he will not vote for the final health care bill if it did not include his abortion language, which is in the House health care bill. He also said there was enough momentum on the Senate front with his views.
"A review of the Senate language indicates a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage," Stupak said in a written statement today. "Further, the segregation of funds to pay for abortion is another departure from current policy prohibiting federal subsidy of abortion coverage. While I and many other pro-life Democratic House members wish to see health care coverage for all Americans, the proposed Senate language is unacceptable."
Senate Democratic leaders also took out one of the most controversial aspects of the health care bill, the option of a government-run insurance plan and replaced it with a "multi-states" plan that would be managed by the Office of Personnel Management.
Nelson and Sen. Joe Lieberman, an independent of Connecticut, had emerged as leading opponents of a public option plan and a subequent proposal to expand Medicare to Americans between the ages of 55 and 64.
Democratic leaders needed both Nelson and Lieberman's support to avoid a Republican filibuster of their health care bill, even though liberal Democrats complained that they were conceding too much to a few lawmakers.
Even as Nelson expressed support for the Senate health care bill, he shot a warning signal to his party members, saying he reserves the right to oppose the legislation in the future if material changes are made after Senate passes the bill and it goes to conference with the House, where the two chambers would attempt to merge their differences.
To appease the liberal wing of the party that wanted a public option, Democratic leaders included a medical loss ratio provision that would demand greater accountability from insurance companies and create more competition. Democratic aides say insurance companies will be forced to spend more money on care and less money padding their bottom line.
In his statements today, Obama specifically mentioned those changes.
"Between the time the bill passes and the time when the insurance exchange gets up and running, there will now be penalties for insurance companies that arbitrarily jack up rates on consumers," the president said. "A recent amendment has made these protections even stronger. Insurance companies will now be prohibited from denying coverage to children immediately after this bill passes."
Reid vowed to get the Senate health care bill passed by Christmas, despite Republican attempts to delay debate.
The GOP's Senate leadership today assailed the legislation, as expected.
"This bill is a legislative train wreck of historic proportions," said Minority Leader Mitch McConnell, R-Ky. "They [Democrats] are so eager to claim a victory, they'll simply do anything to jam it through in the next few days."
Even as Reid expressed confidence that he had the 60 votes needed for the health care bill to pass the Senate, Republicans said they will not give in and stay until Christmas day, if it came down to it.
Sen. Richard Burr, R-N.C., accused Nelson of getting a permanent special Medicaid deal for Nebraska. Burr said the Nebraska senator knew how to play the TV show, "The Price is Right," and charged that the bill was about picking winners and losers.
Defense Bill Passage Clears Way for Health Care Bill Vote
Earlier today, Senate Democratic leaders overcame a major hurdle and paved the way for a health care vote when the Senate gave final congressional approval to a $636 billion bill to fund the Defense Department and extend some unemployment benefits.
The bill will now go to the president for his signature.
The funding pays for the normal operations of the Pentagon and provides money for the wars in Iraq and Afghanistan.
There is an additional $10 billion in the bill for short-extensions -- through the end of February -- of unemployment and COBRA benefits, surface transportation programs and some Small Business Association loans. The bill also temporarily extends anti-terrorism portions of the Patriot Act.
ABC News' Dean Norland and Z. Byron Wolf contributed to this report.