Jonathan Ernst/Reuters Senator Ben Nelson, sponsor of an amendment tightening restrictions on federal funding for abortion, on Capitol Hill on Tuesday.Update | 9:24 p.m.
The Senate majority leader, Harry Reid of Nevada, said on Tuesday night that he had reached “a broad agreement” among a group of 10 Democrats who have been working to resolve the dispute over a proposed government-run insurance plan that has posed perhaps the biggest obstacle to major health care legislation.
Mr. Reid refused to provide details, saying only that the group of 10 senators – five liberals and five centrists – would be sending proposals to the Congressional Budget Office for analysis. The broader Senate Democratic caucus appeared to be in a state of confusion with even some senior party leaders saying they were unaware of any agreement.
But Democratic aides said that the group had tentatively agreed on a proposal that would replace a government-run health care plan with a menu of new national, privately-run insurance plans modeled after the Federal Employee Health Benefits Program, which covers more than eight million federal workers, including members of Congress, and their dependents. (See this earlier Prescriptions article about how the group of 10 has been thinking about this approach.)
A government-run plan would be retained as a fall-back option, the aides said, and would be triggered only if the new proposal failed to meet targets for providing affordable insurance coverage to a specified number of people.
The agreement would also allow Americans between age 55 and 64 to buy coverage through Medicare, beginning in 2011.
The announcement came after the Senate on Tuesday voted against adding tougher abortion insurance restrictions to the health care bill.
The vote rejected an amendment proposed by Senator Ben Nelson, Democrat of Nebraska, that would have barred any health plan purchased even partly with new federal subsidies from covering the procedure.
Abortion rights advocates said that Mr. Nelson’s proposed language, which would mirror restrictions included in the health care bill approved last month by the House, posed one of the greatest threats to women’s freedoms since Roe v. Wade, the landmark Supreme Court decision that established a right to abortion.
The vote was 54 to 45, with two Republicans, Senators Susan Collins and Olympia J. Snowe of Maine, joining 50 Democrats and two independents to defeat the Nelson proposal. Seven Democrats and 38 Republicans voted in favor of the proposal.
The defeat of the amendment was quickly hailed by the women senators who championed the battle against it, Senators Barbara Boxer of California and Barbara A. Mikulski of Maryland.
But it raised yet another question about the prospects of the larger health care legislation by casting further doubt on Mr. Nelson’s willingness to support the bill.
To wrap up debate and move to a final vote, the majority leader, Harry Reid of Nevada, will need the unanimous backing of all 60 members of his caucus, including Mr. Nelson. Or he will need to win over enough Republicans to make up for any defections.
So far, no Republican has expressed a willingness to support the broader bill, but the two senators from Maine, particularly Ms. Snowe, are being courted aggressively by both Mr. Reid and the Obama White House.
The vote also put the Senate’s language on insurance coverage for abortions at odds with the House, which approved tougher restrictions in an amendment that helped secure the votes needed for final approval of the bill.
That House amendment, sponsored by Representative Bart Stupak, Democrat of Michigan, was virtually identical to the Nelson amendment.
The health care legislation seeks to broadly expand insurance coverage to more than 30 million Americans without benefits, in part by providing federal subsidies to moderate-income people to help them buy private coverage.
The Stupak amendment barred any plan purchased even partly with those subsidies from covering abortions.
The language that remains in the Senate bill would allow private plans to cover abortions. It would require at least one government-approved plan in each state to cover abortions and at least one government-approved plan in each state not to cover abortions.
Federal dollars could not be used to pay for abortions, so the Senate bill would require insurance plans to segregate privately paid premiums to use that money for abortions. Opponents of abortion rights have described the segregation of funds as a meaningless accounting trick.
Under existing federal law, generally referred to as the Hyde amendment, government money cannot be used to pay for abortions, except with rare exceptions for rape, incest and the health of the mother.
Both sides in the debate said they were simply seeking to apply that existing law to the proposed health care legislation. But the legislation would create circumstances not yet confronted by current law.
Senator Orrin G. Hatch, Republican of Utah, and a co-sponsor of Mr. Nelson’s amendment, said he believed that supporters of abortion rights would try to use the language in the health care bill to ultimately undo the Hyde amendment and permit further use of government funds for abortions.
The defeat of Mr. Nelson’s amendment created an odd circumstance in which the normally more liberal House now has language in its bill that is more conservative than that of the normally more conservative Senate.
The House speaker, Nancy Pelosi, herself a staunch defender of abortion rights, had tried desperately to strike a deal on abortion language in the days leading up to the vote on the health care bill. She nearly succeeded. Mr. Stupak and other opponents of abortion rights were willing to accept a compromise, but defenders of abortion rights – including some of Ms. Pelosi’s own closest allies in the House – balked. After the compromise fell apart, the result was even tougher language on restricting insurance coverage of abortions.
In the House Tuesday, Representative Lois Capps, Democrat of California, who proposed earlier compromise language on insurance coverage of abortions, issued a statement praising the Senate vote.
“This amendment was far too extreme, going well beyond current law to deny private health insurance coverage of abortion services in the U.S.,” Ms. Capps said in the statement. “Its adoption would have mean more women would have their reproductive health choices made by politicians and anti-choice zealots in Washington.”
But even some strong Democratic supporters of the health care legislation said that the current abortion language in the Senate bill posed an obstacle to final passage. Senator Kent Conrad, Democrat of North Dakota, and one of the seven Democrats to vote in favor of the Nelson amendment, said that further compromise would be necessary.
In addition to Mr. Conrad and Mr. Nelson, the other Democrats to vote in favor of the tougher language were Evan Bayh of Indiana, Bob Casey of Pennsylvania, Byron Dorgan of North Dakota and Mark Pryor of Arkansas.
The abortion issue is one of the most emotional and politically charged in the health care debate. But it is hardly the only hurdle that Democrats face as they try to move forward with the legislation that embodies President Obama’s top domestic priority.
Before and after the vote on Mr. Nelson’s amendment, a team of 10 Democrats worked furiously to broker a deal over the proposed creation of a government-run health insurance plan, or public option, to compete with private insurers.
The emerging deal would remove the public option from the bill, setting up yet another conflict with the House measure, which includes a public plan. But Senate Democrats seem unable to muster the 60 votes needed with the public option included.
Senator Joseph I. Lieberman, independent of Connecticut, has said he would vote against the bill, in order to defeat the public option. And other Democrats have voiced similar resolutions, although without so certain threat.
Instead of a public plan, the Democrats’s team of 10 are proposing a new menu of national, private insurance plans modeled after the Federal Employee Health Benefits Program, which covers more than eight million federal workers, including members of Congress, and their dependents.
The plans would be overseen by a federal agency, the Office of Personnel Management, which would negotiate rates and coverage terms.
In addition, the Democrats are discussing a proposal that would allow Americans between the ages of 55 and 64 to purchase coverage under Medicare, which now covers Americans age 65 and over. The deal might also include a two-year extension of the Children’s Health Insurance Program, which was reauthorized earlier this year and is set to expire in 2013.