Outnumbered Republicans are pledging to delay passage of historic health care legislation as long as possible after jubilant Democrats locked in Nebraska Sen. Ben Nelson as the 60th and decisive vote.
Nelson's backing puts President Barack Obama's signature issue firmly on a path for Christmas Eve passage. Democrats will need to show 60 votes on two additional occasions, with the next -- and most critical -- test vote set for about 1 a.m. Monday.
"This bill is a legislative train wreck of historic proportions," the Republican leader, Sen. Mitch McConnell of Kentucky, said at a Saturday news conference. He pointed to cuts to Medicare that the Congressional Budget Office said totaled more than $470 billion over a decade, with reductions in planned payments to home health care agencies and hospices. He also said the bill includes "massive tax increases" at a time of double-digit unemployment.
A senior adviser to Obama criticized Republican senators on Sunday for trying to halt final action, saying the American people deserve a vote.
"The Republican party has spent a month engaged in parliamentary maneuvers and dilatory tactics to try and prevent a vote," David Axelrod, the Obama adviser, told ABC's "This Week."
Vice President Joe Biden wrote in The New York Times Sunday that senators should support the bill because "it represents the culmination of a struggle begun by Theodore Roosevelt nearly a century ago" to improve health care.
"I would vote yes for this bill certain that it includes the fundamental, essential change that opponents of reform have resisted for generations," he wrote.
With senators set to resume debate Sunday afternoon, Republicans note the CBO concluded that under the bill, "federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care."
To get Nelson's vote, Senate Majority Leader Harry Reid, D-Nev., agreed to a series of concessions on abortion and other issues demanded by Nelson, a Democrat, and then informed Obama of the agreement as the president flew home from climate talks in Copenhagen.
The compromise tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. It would also allow states to restrict coverage for abortion in new insurance marketplaces.
No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money.
Moreover, individual states would be able to prohibit abortion coverage in plans offered through the exchange, but after passing specific legislation to that effect. The only exceptions would be those allowed under current federal law.
Obama welcomed the breakthrough on health care legislation on Saturday, saying in a statement at the White House, "After a nearly century-long struggle, we are on the cusp of making health care reform a reality in the United States of America."
The CBO said the Senate bill would extend coverage to more than 30 million Americans who lack it. It also imposes new regulations to curb abuses of the insurance industry, and the president noted one last-minute addition would impose penalties on companies that "arbitrarily jack up prices" in advance of the legislation taking effect.
CBO analysts also said the legislation would cut federal deficits by $132 billion over 10 years and possibly much more in the subsequent decade.
At its core, the legislation would create a new insurance exchange where consumers could shop for affordable coverage that complied with new federal guidelines. Most Americans would be required to purchase insurance, with federal subsidies available to help defray the cost for lower and middle income individuals and families.
In a concession to Nelson and other moderates, the bill lacks a government-run insurance option of the type that House Democrats inserted into theirs. In a final defeat for liberals, a proposed Medicare expansion was also jettisoned in the past several days as Reid and the White House maneuvered for 60 votes.