By Noam N. Levey and Janet Hook Los Angeles Times Staff Writers
December 19, 2009 | 7:01 a.m.
WASHINGTON — With a critical vote looming this weekend, Senate Democrats reached a deal with the lone Democratic holdout -- Nebraska Sen. Ben Nelson, who will back the party's healthcare bill after settling weeks of negotiating over abortion.
That would give Democrats the 60 votes they need to quash a series of Republican-led filibusters and pass a bill by Christmas.
Nelson, who was pushing for tougher restrictions on federal funding for abortion, reached the agreement with Senate Majority Leader Harry Reid's office after round-the-clock talks with Reid and Sen. Barbara Boxer (D-Calif.), a leading supporter of abortion rights.
The deal paved the way for Reid to introduce a long list of proposed changes to the legislation this morning and then file a series of procedural motions that would allow the Senate to take a final vote on the bill on Christmas Eve.
That requires three procedural votes staggered between Monday morning and Wednesday afternoon, a tight timeline that Democrats must adhere to if they are to pass a healthcare bill by their self-imposed deadline.
The Senate bill will have to be reconciled with healthcare legislation passed by the House of Representatives in November. That process could drag on for months, although Democrats are hoping to finish work in January.
This morning, Republicans almost immediately resumed their delaying tactics, insisting that Reid's proposed changes be read aloud on the Senate floor. That is expected to consume much of the day Saturday.
The most politically explosive change to Reid's healthcare bill is the elimination a new government insurance plan for Americans who do not get insurance through work. Instead, Reid's amendment would authorize the federal government to contract with a nonprofit insurer to provide consumers with an alternative to plans offered by commercial insurers. The nonprofits would be subject to an additional level of federal oversight to ensure that they offered quality, affordable coverage.
The majority leader also made dozens of additional steps to satisfy the demands of his diverse caucus. The modified bill would further tighten regulations on insurers, including a new requirement that some companies commit at least 85% of their annual expenses to paying medical claims for their customers. (A similar provision designed to control what is known as the "medical loss ratio" is included in the House healthcare bill.)
The bill would also give state and federal officials greater authority to regulate how much insurance companies could raise their premiums each year.
Many consumer groups believe this check, which is inspired by regulations that California has used for decades to control property and auto insurance, offers a vital protection for consumers if they are required to buy health coverage.
Reid did not slash a proposed tax on high-cost, so-called "Cadillac" health plans, despite demands from labor unions who fear the tax would hit many of their members who have given up wage hikes over the years in exchange for more generous health benefits.
The bill imposes a 40% excise tax on plans worth more than $8,500 for single coverage and $23,000 for family coverage, with some exceptions.
Reid did eliminate a proposed new excise tax on elective cosmetic surgery and replaced it with a tax on indoor tanning services.
In a nod to calls from many healthcare experts and centrist lawmakers, Reid expanded sections of the legislation designed to restrain the rapid growth of medical spending by forcing hospitals and other medical providers to deliver care more efficiently.
Most of the changes would speed implementation of Medicare programs that reward hospitals that do more to coordinate the care their patients receive and deliver better clinical outcomes.