US president Barack Obama’s top domestic policy priority - is poised for a critical but far-from-final vote today.
Republicans are nearly unanimous in fighting the overhaul plans drawn up at Mr Obama’s request by Democrats in both the House of Representatives and the Senate.
Republicans believe the Democrats’ reform measure will unduly increase the national debt and wrongly intrude on the private sector and some members of the opposition see it as a chance to score political points by sinking a measure at the core of Mr Obama’s presidency.
Most controversial among those issues is the establishment of a government programme in competition with the private insurance industry.
That, for now, has been written out of the Senate Finance Committee plan that goes to a vote among members of the panel today.
Mr Obama has promised to reform the health care system, insisting all Americans are entitled to insurance coverage, costs have to be cut significantly to reduce the soaring national debt and that private insurers must be prevented from denying coverage or dropping it when a person becomes seriously ill.
The huge obstacles to passage of legislation that would deliver on those pledges are forcing Mr Obama to spend heavily from his store of political capital, battling hard to prevent a congressional rebuke that could seriously weaken his standing after only nine months in office.
If the Democratic-controlled Senate Finance Committee passes the proposal today as expected, the 10-year, $829 billion health care overhaul would go for debate among all 100 senators.
But Republicans, while a minority in the Senate, hold sufficient votes to stall passage through a procedure known as a filibuster. That expected move would require majority Democrats to muster all 60 of their votes, not a simple majority of 51, to end debate and bring a bill to a final vote.
Blue Dog Democrats - fiscal conservatives from swing states - are opposed to the bill coming out of the committee, so that gaining the 60 votes to break a filibuster is far from certain. And even if that happens, the health care bill would then move to what is known as a conference committee to blend the Senate bill with one passed by the House.
The lower house, where the Democrats have a larger majority and a filibuster is not possible, is considering three versions of the legislation, any one of them assured of passage and far more inclusive of an outcome sought by the White House.
Democrats got a boost last week when the non-partisan Congressional Budget Office said the Senate Finance Committee bill would, in fact, cut the government deficit over 10 years and end up covering 94 per cent of Americans.
But the private insurance industry hit back on Sunday with a study that claimed the bill could end up in time adding hundreds, perhaps thousands of dollars to the cost of a typical policy.
Insurers played a major role in defeating then-president Bill Clinton’s health care plan in the 1990s, the last attempt at overhauling the system.
AP