Photo by George Lauby Ben Nelson

Facing a firestorm of controversy, the last vote fell in place Saturday to enact federal health care reform.

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Sen. Ben Nelson said he would vote for reform, paving the way for the bill’s passage before Christmas.

Before Nelson agreed to vote for the bill, the bill was rewritten to prevent federal money from being spent for abortions. Nelson also obtained more federal money for Nebraska for Medicaid.

The Republicans are now running out of options to stop the bill. Nelson is the last vote needed to stop a filibuster, giving the bill’s supporters the 60 votes needed to force a vote, analysts said.

Nelson and a handful of other opponents, notably Sen. Joe Lieberman, withheld their votes to eliminate the "public option" from the bill, infuriating staunch Democrat party supporters.

Nelson said the public option and abortion funding were two provisions that Nebraskans overwhelmingingly opposed in town hall meetings, including one in North Platte in late August.

Republicans were immediately critical. The Nebraska State GOP said Nelson would “rue his fateful decision.”

No funds for abortion

In a crowded news conference Saturday in a Senate hallway, Nelson said he now supports the bill because it doesn’t have the public option (government run health insurance), allows the free market to work, bans federal funding of abortion, and will establish insurance exchanges in each state where people can compare insurance provisions and prices.

He said the bill “walls off federal dollars for abortion in an effective manner” and does not trump nearly a dozen existing state bans on abortion funds.

Under the bill, if a poor person receives a government subsidy for insurance, that person would have to write his or her own check for abortion coverage. And, when state insurance exchanges are created in 2014, each exchange will be required to contain at least one insurance plan that does not even cover abortions.

Also, the bill also allocates $250 million over 10 years to subsidize the cost of adoption for needy parents, Nelson said.

Sen. Mike Johanns, who co-sponsored an anti-abortion-funding amendment with Nelson two weeks ago that was defeated in the Senate, called the new anti-abortion provision “reprehensible.”

On the floor Saturday morning, the Republicans forced Senate clerks to read the entire 330-page compromise proposal, a rarely-used option that stalled proceedings for nearly eight hours.

A final vote on the bill could occur Wednesday, analysts said.

Medicaid

Under the bill, more federal money would help the very low income pay for health care. Medicaid would be expanded to cover all individuals if their income is 33 percent below the federal poverty level, which would add about 30 million people to the Medicaid rolls, the Washington Post estimated.

Currently, individual states must also pay part of Medicaid costs.

Gov. Dave Heineman recently wrote Nelson, fearing that the expanding Medicaid coverage would overwhelm Nebraska's already-tight budget.

Nelson, a long-time critic of unfunded federal mandates, obtained full federal funding for Nebraska for the added Medicaid coverage.

Under the bill, all states will recieve federal funds for additional Medicaid patients for three years, but Nebraska’s share will always continue to come from the federal government.

In the bill

* Every American would be required to obtain coverage or face annual penalties.

* Employers could be fined if they fail to offer affordable coverage.

* Low-income people and very small business would receive subsidies or tax credits to help them pay for coverage.

* A complete ban on pre-existing conditions would take effect in 2014.

* Lifetime limits on health insurance payments would be banned. Annual payment limits would be restricted immediately and permanently banned by 2014.

* Private insurance firms for the first time could offer national insurance policies to all U.S. residents across state lines.

* State-based insurance exchanges, or marketplaces, will be in place by 2014.

* Patients could appeal to an independent state board if an insurer denies a medical claim.

* All insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums to deliver health care to their customers.

* Grants would go to state governments to test ways to eliminate medical malpractice lawsuits (tort reform).

* Among the new taxes that will be levied, couples making more than $250,000 a year would pay an additional 0.9 percent in Medicare payroll taxes. There would also be a tax on, among other things, indoor tanning.

* Medicare funds would be cut by $500 billion over the next 10 years. Regulators would seek to control waste and excessive charges.

For more on the bill see the Washington Post. Try clicking HERE.