WASHINGTON — The Senate on Friday turned back a Republican effort to eliminate a long-term care insurance program to help seniors and the disabled, saving the plan once championed by the late Sen. Edward M. Kennedy in its health overhaul bill.
But the vote exposed the difficulties Democratic leaders face in persuading their own moderates to remain united behind sweeping legislation they hope to deliver to President Barack Obama. Eleven Democrats voted with Republicans, who warned that the new program would turn into a drain on the federal budget.
Republicans fell short in a bid to strike the long-term care plan on a 51-47 vote. They needed 60 votes to prevail.
Two leading Democrats who shaped the health care bill, Finance Committee Chairman Max Baucus of Montana and Budget Committee Chairman Kent Conrad of North Dakota, voted with the GOP — underscoring the gravity of the fiscal concerns.
Known as the CLASS Act, short for Community Living Assistance Services and Supports Act, the idea was originally pushed by Kennedy, the Massachusetts liberal who pursued the goal of health care for all through decades in public service until his death from brain cancer in August.
Workers would pay a modest monthly premium during their careers into the voluntary program. If they become disabled, they would get a cash benefit of at least $50 a day. That can help pay for a home care attendant, for supplies and equipment, to make home improvements such as new bathroom railings, or defray nursing home costs. A version of the plan was passed by the House. The Obama administration supports it.
Sen. John Thune, R-S.D., who led the effort to cut the CLASS Act, said it would add another unaffordable commitment to a government already swamped with debt — and taxpayers would eventually get the bill.
"The CLASS Act is the same old Washington, same old smoke and mirrors, same old games," said Thune. "We are locking in future generations to deficits and debts as far as the eye can see."
But Sen. Chris Dodd, D-Conn., said the Congressional Budget Office projects the program to be fiscally sound for 75 years, without taxpayer bailouts. As a further safeguard, the Senate voted to ensure that funds collected under the plan would only be used to pay out benefits — and not to cover other government obligations.
"It is a solid program that can make a huge difference for millions of Americans, allowing them to lead independent lives with dignity," Dodd said.
Supporters said the program would begin to fill a yawning hole in the social safety net. The cost of nursing homes averages $70,000 a year, and a home care attendant runs about $29 an hour. Medicare only covers temporary nursing home stays. Middle-class households have to exhaust their savings before a senior can qualify for nursing home coverage through Medicaid.
Separately, in a 41-57 vote, the Senate turned back a Republican effort to restore $120 billion in cuts to Medicare Advantage, the private insurance plan that provides seniors with better benefits than the traditional program. Democrats say the government is wasting money overpaying the plans.
The list of Democrats who crossed the aisle to vote against the CLASS Act was a roll call of moderates whom Majority Leader Harry Reid, D-Nev., desperately needs to beat back Republican filibusters and get a final bill off the Senate floor. Among them was Sen. Joe Lieberman, the Connecticut independent.
A dozen or so political moderates hold the fate of the bill in their hands. What makes things unpredictable is that they disagree on two key issues. On abortion coverage and a government health insurance plan, the moderates were lining up in different places.
Reid needs 60 votes to win the last round. He has 60 senators in the Democratic caucus, and some have already said they can't support the bill as it stands now. Lieberman is threatening to filibuster if a government insurance plan stays in. Sen. Ben Nelson, D-Neb., won't vote to advance legislation unless the Senate agrees to strict limits on abortion coverage that liberals won't accept.
As senators prepared to debate into the weekend, it was hard to see how Reid would put together a winning combination. Two Republicans, Maine Sens. Olympia Snowe and Susan Collins may yet be persuaded to vote for the Democratic bill. But they also oppose creating a government plan to compete with private insurers.
Lieberman, Collins and Pennsylvania Democrat Arlen Specter came together Friday to outline an amendment that would give patients better information about the quality of their doctors and insurance plans, and crack down on hospitals where poor sanitation leads to high rates of avoidable infections.
The Senate's Number 2 Democrat, Richard Durbin of Illinois, was unfazed. "We feel like we're moving to the point where soon we can talk about an endgame, where we have an agreement that can bring together 60 votes," Durbin told reporters. "But we're not there yet."