WASHINGTON - With a sweeping U.S. health care overhaul proposal finally on the table, senators who've been waiting months to see the bill are lined up to offer a bevy of contentious changes. One senator said the bill "needs more than just a few tweaks."
Some Democrats see plenty of room for improvement in the bill from Senate Finance Committee Chairman Max Baucus, a Democrat from Montana.
And then there are Republicans, who almost uniformly oppose the measure and may be loathe to hand President Barack Obama a victory on his biggest domestic priority, legislation to rein in skyrocketing health care costs and extend coverage to many of the 50 million uninsured.
America is the only industrialized democracy that lacks a comprehensive national health care system.
Most Americans rely on health insurance partially subsidized by their employer, and they can lose their family's coverage if they lose their job.
After months when health care negotiations in the Senate were confined largely to Baucus meeting privately with five other Finance Committee senators to try to craft a bipartisan deal -- ultimately without success -- the dynamic was noticeably altered Thursday, a day after Baucus produced his long-awaited bill.
Many more senators were in the mix, and many of them had something to say.
"I can find a handful of things that trouble me," said the Senate's No. 2 Democrat, Dick Durbin of Illinois. He cited a new tax on high-value insurance plans that he and other Democrats fear could hit middle-class workers.
The Baucus plan "needs more than just a few tweaks," said Sen. Maria Cantwell, a Washington state Democratic member of the Finance Committee, saying she wanted stronger measures to control health care costs over the long term.
"Put it in perspective," Durbin added. "For months, the debate over health care in the Senate consisted of six people sitting in a room. Now it's been expanded.
"So we have a lot of people who need to become informed, express themselves, ask for changes if they can," Durbin said.
That was happening in earnest Thursday as Baucus convened a full committee meeting on his bill. Senate Democrats met later, and Republicans from the Finance Committee gathered with Republican Senate Minority Leader Mitch McConnell to go over strategy for next week, when Baucus will bring his bill up in committee for amendments -- there will be many -- and votes.
Democratic concerns focused on the new tax on generous insurance plans and on whether subsidies to help lower-income people buy newly required insurance are ample enough. Liberals also continued to question the absence from Baucus' proposal of a government-run insurance plan to compete with private industry. That's a feature of five other health bills in Congress but Baucus omitted it as one of numerous gestures meant to win support from Republicans and moderate Democrats. Baucus included nonprofit cooperatives instead.
His bill also would set up new purchasing exchanges in which individuals not otherwise covered could shop for insurance, and it would bar insurance company practices like denying coverage to people with pre-existing conditions.
Finance Committee Republican Orrin Hatch of Utah was asked on his way out of a meeting with Baucus and others on the committee whether he'd heard anything to lessen his opposition.
"Actually I've got even more concerns," Hatch said, contending that the cost of the bill would end up being much greater than the $856 billion over 10 years that Baucus has cited. Hatch noted that the cost was kept down partly by limiting to one year an expensive fix to avoid scheduled payment cuts to doctors under Medicare. That change is made permanent in the House Democrats' health legislation, which carries a much heftier price tag over $1 trillion.
"There are a lot of things that just bother me to death about the approach that they're taking," Hatch said.
Nonetheless, the release of the bill put new momentum behind Obama's push for a health care overhaul, and Democratic leaders in the House and Senate hope to move to floor action in the fall.
Obama himself pumped up the plan at a rally at the University of Maryland on Thursday, and is set to appear on Sunday talk shows to push for action.
"There's now agreement in Congress on about 80 percent of what needs to be done," Obama told the crowd.
That last 20 percent could still be tough.
Obama had campaigned on a pledge of bipartisanship and has said he wants to reach a compromise with Republicans on a health care package. Liberal Democrats, though, doubt Republicans can be persuaded to support any agreement and want Obama to use his party's strong majorities in both chambers to push through legislation.
But it is not clear that he has the votes to do so. Democrats are now one vote shy of the 60 votes they need to block Republican efforts to derail the bill in the Senate. Also, with congressional elections approaching next year, some Democrats from conservative states are wary about supporting an overhaul that voters may see as too liberal.
That means Baucus' plan may offer Obama his best hope for getting health care legislation passed.
The final version of the bill -- if one gets passed -- could be shaped more by Baucus' plan than by the proposals of any other lawmaker.