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Senate Health Bill's Progress Hinges on Two Southern Dems

Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas emerged several days ago as among the last public holdouts among 58 Democrats and two independents whose votes Majority Leader Harry Reid and the White House must have to overcome the Republicans' attempt to strangle the bill Saturday before serious debate can begin.

Each has moved carefully with an eye on home-state voters. And inside the Senate, each has taken advantage of the political leverage newly available.

A third holdout, Sen. Ben Nelson of Nebraska, issued a statement Friday ending any lingering public suspense about his intentions. "The Senate should start trying to fix a health care system that costs too much and delivers too little for Nebraskans," he said, adding his decision should not be seen as an indication of how he will vote on the legislation itself.

Nelson had been publicly signaling his intentions for more than a week, and his words presumably came as no surprise to Reid or the White House, which issued a statement Friday saying the bill "provides the necessary health reforms that the administration seeks."

This sort of political minuet can be delicate, as shown when the Senate's second-ranking Democrat, Dick Durbin of Illinois, said earlier on Friday that Lincoln had already confided to Reid how she planned to vote.

Republicans, eager to scuttle the bill -- and defeat Lincoln in 2010 -- instantly accused the two-term senator of telling Democratic party leaders before informing her own constituents in Arkansas.

"No other senator speaks for Senator Lincoln. She is still reviewing the bill," declared the senator's spokeswoman, Leah Vest DiPietro, adding her boss had not yet made up her mind. For his part, Durbin sought to quickly close the loop with a statement saying he had been unclear and misinterpreted.

As for Nelson, several officials, speaking on condition of anonymity, said he had insisted Reid omit from the bill any change in the insurance industry's protection from federal antitrust law. The House version of the legislation would expose the industry to scrutiny by both the Justice Department's antitrust lawyers and the Federal Trade Commission.

Reid, who spoke out strongly in favor of the change in antitrust treatment earlier in the fall, left it out of the bill he drafted over several weeks and unveiled on Wednesday.

Lincoln has been the most close-mouthed about her intention. As a committee chairman, she is the most powerful of the group. As the only one of the three seeking re-election next year, she is also the most politically vulnerable.

In public, she has asked that the bill be available for 72 hours before the vote occurs. In private, her demands have been more substantive, according to officials who did not describe them.

She is virtually certain to be criticized no matter what her vote. After the House cleared its version of the legislation this month, a conservative group began airing commercials criticizing Rep. Vic Snyder, D-Ark., for voting in its favor. At the same time, MoveOn.org, a liberal organization, slammed another one of the state's lawmakers, Rep. Mike Ross, for opposing it.

A hint: At home, Lincoln has suggested her vote will be influenced by former President Bill Clinton, who was Arkansas governor for 12 years before winning the White House.

Clinton recently met privately with Senate Democrats, telling them that passing an imperfect bill was better than nothing. "We don't ever go to Washington with the idea that we're going to create a work of art," Lincoln said afterward. "It's got to be a work in progress."

She and the other moderates face pressure from business groups opposed to the legislation. In a statement Friday the Business Roundtable, which represents big company CEOs, said the Senate bill "will not effect the needed changes to measurably improve the American health care system." Democrats and the White House had seized on a report by the same group last week concluding that some of the provisions under consideration by Congress had the potential to tame runaway medical inflation.

Of the three centrists, Landrieu has been the clearest about her intentions, and her interests ranged beyond health insurance to the oysters for which Louisiana is famous. When the Food and Drug Administration proposed banning sales of raw oysters from the Gulf of Mexico during warm weather months, Landrieu and others objected.

A week ago, the agency thought better of the idea and shelved the plan in favor of further study. "I'm really thankful that they listened," said Landrieu, who had met with FDA Commissioner Margaret Hamburg to discuss the issue.

Over recent weeks, Landrieu has issued a string of statements outlining the areas she wanted addressed for the benefit of her constituents -- issues that could be dealt with only after health legislation made it to the Senate floor.

After meeting with Reid almost a month ago, she mentioned the "unique challenges Louisiana is facing in terms of Medicaid."

In a Senate speech and statement, she noted that Louisiana has the highest breast cancer death rate in the country and the lowest female life expectancy of any state. And she said, "Unless something is done, annual health care costs for small firms over the next 10 years are expected to more than double to reach $339 billion in 2018."

Landrieu can point to provisions in the legislation that are designed to attack all three problems.

They include Section 2006.

Reading it is of little assistance. "Special adjustment to FMAP Determination for Certain States recovering from a Major Disaster" is the title, and about two pages of similarly indecipherable legalese follows.

According to the Congressional Budget Office, it will send an additional $100 million to Louisiana to help it cover costs for Medicaid, the federal-state health care program for the poor.

Should Landrieu decide to side with Republicans this weekend, she would also be voting to deny her state those funds.

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