Washington (AP) - After three days of angry debate, the Senate was poised to cast its first vote Thursday on remaking the nation's health care system, with Democrats and Republicans offering amendments that address Americans' fears about women's health and Medicare.
Under the agreement that allowed the votes to take place, the amendments will require 60 votes to pass - making each step in the debate a test of Democratic Party unity.
Waiting in the wings is an amendment to restrict abortion funding, except in cases of rape, incest, or to save the life of the mother. Drafted by an abortion opponent - Democratic Sen. Ben Nelson of Nebraska - it looms as perhaps the biggest challenge for the Democrats.
Majority Leader Harry Reid, D-Nev., accused Republicans of scheming to use delaying tactics to "bring the Senate to a screeching halt" and kill the bill. GOP leader Mitch McConnell of Kentucky says his party is only exercising its rights under Senate rules to make sure the bill gets a full debate. Both sides say they're ready to work weekends.
The first votes Thursday will deal with coverage of preventive screening tests for women, including mammograms and Pap tests for cervical cancer. The issue became politically charged after a government advisory panel recently recommended that most women in their 40s don't need routine mammograms. Republicans called it a harbinger of rationing, and the Obama administration quickly distanced itself from the recommendation.
A bipartisan amendment co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine, would give the health and human services secretary authority to require health plans to cover additional preventive services for women. The Congressional Budget Office said the amendment would cost $940 million over a decade.
Mikulski said her amendment would guarantee that decisions are left to women and their doctors, not placed in the hands of government bureaucrats or medical statisticians. She accepted a modification to her amendment by Sen. David Vitter, R-La., that would specifically prevent the controversial recommendations on mammograms from restricting coverage of the test.
However, Republicans said that Mikulski's amendment still left too much discretion to the HHS secretary. A competing amendment by Sen. Lisa Murkowski, R-Alaska, would prevent the government from using the recommendations of outside advisers to deny coverage of preventive services, including mammograms and Pap tests.
Democrats countered that would go too far, tying the hands of decision-makers if better clinical evidence indicates that some tests are no longer valid.
Votes scheduled later Thursday on Medicare go to the heart of seniors' concerns that cuts from the program used to finance coverage for the uninsured will undermine the quality of care for the elderly.
Sen. John McCain, R-Ariz., is proposing to strip more than $400 billion in Medicare cuts from the nearly $1 trillion bill, and send the whole measure back to committee so a different financing scheme can be found. A competing amendment by Sen. Michael Bennet, D-Col., underscores that no benefits in traditional Medicare will be cut by the legislation. It also clarifies that the Medicare cuts - amounting to a 2 percent slowdown in spending - will extend the life of the program and lower premiums for beneficiaries.
Underscoring the political stakes, McCain, recorded "robocalls" in states that are home to key moderate Democrats asking voters to support McCain's amendment stripping the bill's Medicare cuts. The calls, paid for by the National Republican Senatorial Committee, targeted Nelson, Bennet and Blanche Lincoln of Arkansas.
"On Monday, I introduced the first Republican amendment to the massive health care bill, which would send the bill back to the Senate Finance Committee and stop the Democrats from cutting vital Medicare coverage for our seniors. I need Sen. Blanche Lincoln to join me in this effort," McCain says in the call heard by Arkansas residents.
He asks them to go to an NRSC Web site and sign a petition to Lincoln "urging her to join my effort to fight a Washington, D.C., government takeover of your health care."
The scripts in the other states were identical. Another call by a live operator was heard by voters in North Dakota, which prohibits robocalls, and it delivered the same message, targeted at Sen. Byron Dorgan.
If Democrats prevail in the first series of votes, they face a make-or-break test on abortion funding.
While most Senate Democrats support abortion rights, they need the votes of a handful of abortion opponents in their party to pass the health care bill. Catholic bishops have been adamant in saying they will not accept any compromise that in their view would expand federal funding for abortion. Liberals in the House gave in under pressure, but they're determined to make a stand in the Senate.
Associated Press writers Erica Werner and David Espo contributed to this report.
After three days of angry debate, the Senate was poised to cast its first vote Thursday on remaking the nation's health care system, with Democrats and Republicans offering amendments that address Americans' fears about women's health and Medicare.