Washington (AP) - It takes 60 senators to overhaul the nation's health care system.
Sen. Ben Nelson, a Nebraska Democrat, is making everybody wait for the answer to the burning Washington question: Will he be the sixtieth vote that Senate Majority Leader Harry Reid gets to advance President Barack Obama's health care remake?
Maybe, Nelson says -- if Reid can find a way to put tougher abortion restrictions in the bill and satisfy the legions of anti-abortion Nebraskans. Challenging his party is a role the moderate Nelson has played many times, most notably when he supported then-President George W. Bush's tax cuts in 2001 and 2003.
Now his ultimatum has produced a scramble from Obama's White House to the Capitol either to win over Nelson or find a Republican to vote for the bill. Reid, D-Nev., made Nelson one of 10 negotiators trying to find a compromise on government-run insurance in the bill, keeping him in the circle of influence.
"I'm not blockheaded and I'm not stubborn," Nelson said in an interview. To support the Democrats' bill, though, it must be changed to prevent taxpayer money from going to insurance plans that cover abortions. Reid tried to give him cover by putting the proposal to a vote; as expected, it failed.
"I've carved out what I can live with and what I can't live with," Nelson said, adding that he'd welcome a solution from the leaders. But without one, "I can't get there." He said Sunday he was aware Democrats were still looking for a way to accommodate his concerns. "That's a tall order for people," he said guardedly. "I'm not prescribing ahead what they may be able to do."
In a nod to Nelson, Reid didn't include a provision in the Senate bill to strip the insurance industry of its decades-old exemption from federal antitrust laws despite pressure from other Democrats.
As 2009 ticks away, Nelson remains poised to be the 60th senator Reid needs to block Republican delaying tactics. But he could just as easily become the lone Democrat trying to lead a filibuster. That gives the former two-term governor and insurance executive, liked by his colleagues but little known outside Nebraska, an outsized role over the fate of Obama's top domestic initiative.
Any bill that Obama signs will affect the 2010 midterm elections, in which 34 Senate Democrats -- but not Nelson -- will face election.
Every senator likes attention if it means more clout in the seniority-driven chamber. But being the 60th is a position they tend either to relish or loathe. As their influence grows, so does the pressure to conform.
Nelson, 69, has shown an ability to weather such circumstances and perhaps thrive.
"Ben likes to play that 'Hey, let's all get along; let's figure out how to come together on this,'" said Rep. Lee Terry, R-Neb., a former Omaha city council member now in his sixth House term.
"He puts himself purposely in that role," Terry added, harking back to Nelson's time as governor. "That's Ben. That's his personality. That's his leadership style."
W. Don Nelson, the senator's former state director and longtime friend, said the senator seemed unfazed when they saw each other at a recent event.
"He seemed completely at ease and we even joked about this being Chapter 12 of the same book that started ... when he was sworn in" to the Senate, W. Don Nelson said.
It's been that way for the senator for many years but especially this one.
"He is the 60th vote -- the 60th vote on the stimulus package, the 60th vote on health care, the 60th vote on you name it," said freshman Sen. Mike Johanns, R-Neb. "He's right on the bubble."
Suspense swirled around the insurance executive when he entered statewide office. Nelson became governor of the Cornhusker State in 1991 after a pair of squeakers in which he won the Democratic primary by 41 votes and the general election over incumbent Gov. Kay Orr by less than 1 percent. With a bit of self-deprecation, he nicknamed himself "Landslide Ben."
Four years later, he really was. Nelson bucked the so-called Republican Revolution in 1994 and won a second term by 47 percentage points. His next victory was tight: In 2000, he won the Senate seat held by retiring Democrat Bob Kerrey, 51-49 percent.
Nelson quickly built a reputation as one of the Senate Democrats most likely to support Bush's initiatives and to cut deals to pass them. Before Nelson's freshman term was half-over, his horse-trading helped pass a pair of Bush tax cuts. He helped broker a bill to allow Bush, but not future presidents, override collective bargaining rights by homeland security workers.
His state voted for Republican Sen. John McCain for president last year and re-elected Bush over Democrat John Kerry by 33 percentage points in 2004.
So appealing was Nelson to the Republicans that Bush tried to persuade the freshman senator to become his agriculture secretary. Nelson turned down the offer; Nebraska's Republican governor would have appointed his successor and Democrats would have lost the seat.
The gesture was appreciated by Nelson's Democratic colleagues, who tolerate his ideological infidelity on some issues because on others, he has walked with them. Notably, Nelson was one of the Gang of 14 who in 2005 helped negotiate the end to a procedural standoff over judicial nominations.
He has also built goodwill by promising senior Democrats, especially Reid, never to surprise them with his positions. Holding fundraisers for those up for re-election helps, too.
That, and Nelson's affable nature, is why he found himself in the Nebraska woods in early November, giving New York Sen. Chuck Schumer, a fierce gun control advocate, "a hunter safety course on steroids." Nelson was holding a fundraiser for Schumer's re-election campaign -- attended, Nelson said, by billionaire Warren Buffett. But Schumer wanted to go hunting, too.
The pair insist that Brooklyn-born, Harvard-educated Schumer bagged three birds that weekend. Nelson, though, dressed them.
Health care, along with the delicate task of courting Nelson's vote, was not seriously discussed, the senators say. But Schumer came away with an appreciation for just how conservative Nelson's constituents are.
"He is the lead Democrat in one of the most Republican states in the country," Schumer said. And though Nelson appears able to handle and even joke about the pressure facing him, "Nobody thinks he's doing this for personal aggrandizement."
Associated Press writers Erica Werner and Ken Thomas contributed to this report.
For Sen. Ben Nelson to support his party's health care bill, he says it must be changed to prevent taxpayer money from going to insurance plans that cover abortions.