Dec. 20 (Bloomberg) -- The U.S. Senate is poised tomorrow
to take an early morning vote that will lead toward passage of
the most sweeping overhaul of the nation’s health-care system in
more than four decades.

The vote to cut off debate is scheduled for 1 a.m., Monday,
in a U.S. Capitol blanketed by a snowstorm and filled with weary
senators and staff. Democrats, finally united in favor of the
bill, are using the clock to overcome delaying tactics by
Republicans universally opposed to the effort.

Senate Majority Leader Harry Reid plans to win final
passage by Dec. 24 now that he secured the vote of his party’s
last holdout, Nebraska Senator Ben Nelson. The 10-year, $871
billion bill is designed to cover 31 million uninsured
Americans, curb costs and place new restrictions on insurers.

“The American people will have the vote they deserve on
genuine reform,” President Barack Obama, who has made the issue
his top legislative priority, told reporters yesterday. “We are
on the cusp of making health-care reform a reality.”

Nelson had held out the possibility Reid wouldn’t meet his
deadline of Christmas passage as he objected to parts of the
bill, giving critics hope for more time to marshal opposition.
He finally struck a deal that satisfied his demand to keep U.S.
subsidies from being used for abortion and won an agreement for
more aid to help Nebraska provide coverage for the uninsured.

‘Powerful Moment’

The agreement came late on Dec. 18 over a handshake.

“It was a pretty powerful moment,” said Reid, a Nevada
Democrat. “That’s what this place is built on, handshakes.”

Reid needed Nelson’s support because passage will require
all 60 votes controlled by Democrats to cut off stalling tactics
from Republicans, who say the measure would raise taxes, hurt
insurers and widen the federal budget deficit.

The Republican leaders in both the House and Senate, Ohio
Representative John Boehner and Kentucky Senator Mitch
McConnell, called the bill a “monstrosity.”

Reid’s plan would cover 94 percent of eligible Americans
under 65, and reduce the deficit by $132 billion over its first
decade, the Congressional Budget Office estimated.

Like the $1 trillion measure passed Nov. 7 by the House,
the Senate plan would require Americans to get health coverage
or pay a penalty. It would expand the Medicaid health program
for the poor, set up online insurance-purchasing exchanges and
provide subsidies for those who need help buying policies. If it
passes the Senate, the bill would then have to be reconciled
with the version passed by the House and signed by Obama.

Nelson warned that his vote isn’t guaranteed if the bill is
revised much in negotiations with the House. If there are big
changes, “I will vote against it,” he told reporters.

Winners and Losers

Health insurers and companies such as medical-device maker
Medtronic Inc. of Minneapolis and drugmaker Pfizer Inc. of New
York would get millions of new customers with the extension of
coverage. Their industries would also face billions of dollars
in new fees.

Insurers such as Minnetonka, Minnesota-based UnitedHealth
Group Inc. would be required to accept all new clients,
regardless of pre-existing conditions and face limits on how
much revenue can be spent beyond covering medical expenses.

America’s Health Insurance Plans, the industry’s Washington
trade group, said the bill would “increase costs for families
and small businesses and disrupt the quality coverage on which
millions of Americans rely today.”

No Public Option

A 383-page amendment Reid offered yesterday made some major
and minor changes to the proposed legislation.

Gone was a new government-run insurance program, or public
option, designed to compete with private insurers. As an
alternative, the U.S. Office of Personnel Management, which
oversees benefits for all civilian federal workers and members
of Congress, would contract with private insurers to offer
multistate plans on the insurance exchange.

Reid dropped plans for a tax on cosmetic surgery, dubbed
the “Bo-tax,” in favor of a 10 percent levy on indoor tanning
salons. And he raised a Medicare payroll tax hike to 0.9
percent, from 0.5 percent earlier, on individuals earning more
than $200,000 or families making more than $250,000.

Reid also boosted penalties for companies that don’t
provide health insurance. Any company with more than 50
employees could face a penalty of $750 per worker, multiplied by
the total number of full-time workers it employs, if just one
obtains subsidized coverage through an exchange. That’s up from
a penalty of $400 in an earlier draft.

Abortion Fight

On abortion, the legislation would set up an accounting
procedure to prevent government funds from being used to fund
abortions covered by private insurance on the exchanges. States
would be able to keep their own prohibitions on abortion
coverage, and the exchanges would have to offer at least one
plan that doesn’t cover the procedure.

Nelson said the language satisfied him, though it drew
criticism from antiabortion groups. The Nebraska lawmaker also
won another prize, with additional Medicaid costs to his state
being absorbed by the federal government.

“A number of states are treated differently than other
states,” Reid told reporters. “That’s what legislation is all
about. Compromise.”

To contact the reporters on this story:
Laura Litvan in Washington at
llitvan@bloomberg.net
Kristin Jensen in Washington at
kjensen@bloomberg.net