Democratic Sen. Ben Nelson stepped onto dangerous terrain and stood his ground Friday, praising the health care reform law during an address to the Nebraska Medical Association.

"It already has done a lot of good," he said, while also expressing his willingness to be open to changes and improvements.

"I agree it's far from perfect," Nelson told the physicians.

Despite its flaws, he said, the 2009 legislation will "end up helping tens of millions of Americans" who have been unable to afford health care coverage and have either avoided or not had access to timely care.

"I am willing to fight to improve it, but not to repeal it," Nelson said.

Nelson encountered a number of concerns about the legislation during a question-and-answer session and was challenged by one doctor who questioned whether he was "still a citizen representative" after 11 years in the Senate.

But Dr. Ron Klutman of Columbus received considerable applause when he praised Nelson for supporting health care reform and securing "the ability to give everybody care" in a timely fashion before health conditions have reached life-threatening proportions.

"I'm tired of people dying in my office," Klutman said.

Nelson provided the climactic 60th vote that cleared the way for Senate enactment of the health care reform bill.

Already, he said, it has eliminated the ability of insurance companies to deny coverage for children with pre-existing conditions. And that has an impact on 106,000 children in Nebraska, he said.

In 2014, no one can be denied coverage because of pre-existing conditions, he said.

The new law already provides access for young adults up to age 26 to be covered on their parents' health insurance policy, Nelson said. And that could affect 7,600 young Nebraskans, he said.

Some small companies already are taking advantage of new tax credits to provide health insurance coverage for their employees, Nelson said.

The economic reality of rising health care costs and growing numbers of Americans without any coverage demanded change, he said.

"But I do hear your concerns," Nelson said.  "I will continue to advocate for change."

Reach Don Walton at 402-473-7248 or at dwalton@journalstar.com.