A holdout no more, Democratic Nebraska Sen. Ben Nelson agreed Saturday to provide the 60th and deciding vote for Senate passage of sweeping health care legislation, capping a year of struggle and a final burst of deadline bargaining.
Nelson had a brief response - "Yeah" - when asked whether he would support the measure as he strode into a private caucus of fellow Democrats.
With that vote, President Barack Obama's Senate allies appear on track to pass the legislation by Christmas, overcoming Republican opposition and a swirling early winter snowstorm.
Nelson disclosed his decision as Majority leader Harry Reid unveiled a final series of changes to the measure, including concessions to Nelson on abortion, Medicaid funding for his state and more.
The legislation includes new limits designed to limit insurance company profits and overhead, by requiring them to spend 80 percent of their premium income on medical care for individual insurance policies, and 85 percent for group policies.
On abortion, the measure would let a state disallow coverage in new insurance exchanges by passing a law to that effect. Additionally, it sets up a mechanism to segregate funds that would be used to pay for abortions from federal subsidy dollars flowing to health plans.
Federal law now prohibits public money for abortions, except in cases of rape, incest or to save the life of the mother. From the beginning, the issue has been how those restrictions would be applied to a new stream of federal money under the overhaul bill.
Abortion rights supporters argued that abortion is a legal medical procedure, already covered by many insurance plans. Abortion opponents said any weakening of current federal restrictions would amount to a massive new subsidy for abortion.
Under Reid's bill, no health plan would be required to offer coverage for the procedure. In plans that do cover it, beneficiaries desiring the coverage would have to pay for it separately, and the plan would have to keep the funds in a separate account.
The developments occurred as Republicans dug in to delay the inevitable for as long as possible. They objected when Reid sought permission for Nelson to announce his decision in a speech on the Senate floor, then forced Senate clerks to read aloud the text of the 383-page package of changes in the legislation, a process expected to consume hours.
Republican opposition, coupled with Senate rules requiring 60 votes to overcome a filibuster, gave Nelson enormous leverage as he pressed for concessions that included stronger restrictions on abortions to be covered by insurance policies offered in a newly overhauled health care system.
Officials said he was also seeking to ease the impact of a proposed insurance industry tax on nonprofit companies, as well as win more federal money to cover Nebraska's cost of treating patients in Medicaid, the state-federal health care program for the poor.
These officials, speaking on condition of anonymity because of the sensitivity of the talks, said the administration and Democratic leaders had offered concessions on those points.
Nelson already rejected one proposed offer on abortions as insufficient, and the presence in the talks of Sen. Barbara Boxer, D-Calif., indicated additional changes were on the table.
Boxer has a strong record in favor of abortion rights. She told reporters as she left the Capitol at the end of Friday evening there had been progress made on the issue of separating personal funds, which may be used to pay for abortions, from federal dollars, which may not.
The issue is contentious because the legislation provides federal subsidies to help lower and middle-income families afford insurance and the other federal health care programs ban the use of government money to pay for abortions.
Obama devoted his weekend radio and Internet address to the issue he campaigned on in 2008.
"Now - for the first time - there is a clear majority in the Senate that's willing to stand up to the insurance lobby and embrace lasting health insurance reforms that have eluded us for generations," Obama said. "Let's bring this long and vigorous debate to an end."
"As this difficult year comes to a close, let's show the American people that we are equal to the task of meeting our great challenges," he said.
In the Republican response, Sen. John McCain warned that rushing through legislation now would do more harm than good.
"The best thing government could do to ensure more Americans have access to health care insurance is to institute reforms that would rein in costs and make health care more affordable," said McCain, R-Ariz. "Regrettably, there's nothing in this legislation that effectively addresses the problem."
In an article she wrote in Saturday's Washington Post, Vicki Kennedy, the widow of Sen. Ted Kennedy, D-Mass., said that while the Senate bill is imperfect, it would achieve many of the goals her husband fought for over four decades.
"I humbly ask his colleagues to finish the work of his life, the work of generations, to allow the vote to go forward and to pass health care reform now. As Ted always said, when it's finally done, the people will wonder what took so long," she said.
The legislation would expand coverage to 30 million people now uninsured and try to curb rising health care costs. Insurance companies would be prohibited from denying coverage to people with health problems, or charging them more. All Americans would be required to have health insurance, or eventually face fines. The nearly $1 trillion, 10-year cost would be paid for mainly with Medicare cuts and new taxes on insurance companies and other parts of the health care industry.
The week saw an intraparty brawl among Democrats, with liberals seething over the compromises Reid has already made to keep the bill moving.
Gone is a government insurance plan modeled on Medicare. So is the fallback, the option of allowing aging baby boomers to buy into Medicare. The major benefits of the bill won't start for three or four years, and then they'll be delivered through private insurance companies.
This program aired on December 19, 2009. The audio for this program is not available.