SCOTTSBLUFF - Sen. Ben Nelson said Monday he'd prefer a health care reform package that centers on cost savings this year, leaving extended insurance coverage for a later date.

Such a scenario would give 2010 voters an opportunity to weigh in on "what's been done and what remains to be done," Nelson said during an interview a day after he hosted two health care meetings in western Nebraska.

Nelson was quizzed by concerned constituents at polite public sessions in McCook and Scottsbluff.

During those meetings, Nelson told Nebraskans the raging health care reform battle in Washington is "not even halfway through the first quarter."

The focus should be "slowing down the growth of costs" for health insurance and health care, he said, including fixing funding challenges that face Medicare.

"Doing nothing is not the right option," he said.

"I understand your frustrations," Nelson told 225 people who gathered at the McCook Senior Center.

"My vote is not on autopilot for anybody," he said to a round of applause.

Nelson, who is viewed as a key Democratic swing senator in the health care debate, appeared to establish some boundaries this weekend for a package that could receive his support.

"We need to get started by controlling costs and need more time to figure out how to pay for extended coverage," he said during an interview as he flew out of Scottsbluff for Omaha.

That extra time would allow additional economic recovery that could make it easier to provide coverage for millions of uninsured Americans, he said.

"Change, not health care reform, was the issue" in the 2008 presidential election, Nelson said.

But health care reform could be a defining issue in the 2010 congressional elections, he said, giving voters an opportunity to help shape the outcome.

"Public debate can occur in the context of an election," he said.

Nelson appeared to settle on 65 Senate votes as a figure that would provide him a comfort level in terms of establishing a level of bipartisan support for a bill.

"I think anything less than that would challenge its legitimacy," he said.

A minimum of five Republican votes would be required to reach a total of 65 senators.

Sixty votes would be sufficient to clear a Republican filibuster and win passage of the legislation.

"It would be a tremendous mistake to jam it through with 50 votes" under the Senate's arcane budget reconciliation process, Nelson said.

His concerns about a public option insurance alternative have hardened over time into outright opposition.

However, he told his McCook audience, "I would consider the right kind of trigger" instituting a public option if there is not a competitive private insurance marketplace.

"I'm concerned a public option up front could undermine (private) insurance coverage for 200 million Americans," Nelson told about 280 people at Western Nebraska Community College in Scottsbluff.

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"I'm not going to support anything that would add to the (federal) deficit," he added.

In a diverse Scottsbluff audience of all ages were two cowboy hats and one red Obama T-shirt. Half a dozen demonstrators supporting a public option stood outside at the street curb waving signs.

"It would be great to have some public option or nonprofit alternative as a backstop to private insurance," said Paul Janda of Scottsbluff, who wore the Obama T-shirt.

In McCook, a couple sported Tea Party T-shirts.

"I am quite certain government would do a poorer job running health care than private industry would," said Vern Friesen of Wallace.

"I'm concerned about transparency," Carol Friesen said. "We can't afford to do a rush job."

A number of questioners at both sites expressed concern about possible loss of Medicare benefits.

Nelson completed his western swing by joining two Cabinet officers on a crisp morning under a bright blue sky in front of the jagged cliffs at Scotts Bluff Monument.

Gov. Dave Heineman and Rep. Adrian Smith also participated in the outdoor ag forum featuring Secretary of Agriculture Tom Vilsack and Secretary of the Interior Ken Salazar.

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

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