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Ben Nelson
Sen. Ben Nelson (AP file)

Sen. Ben Nelson's dramatic decision Saturday to vote for enactment of historic health care reform ignited a predictable firestorm.

Nelson negotiated a number of concessions that will strengthen health care services in rural Nebraska and lift an expanded Medicaid funding burden from the state.

But the anti-abortion funding language in the agreement leading to his support triggered some political dynamite.

In a stunning choice of words, Republican Sen. Mike Johanns described the abortion compromise negotiated by his Nebraska colleague as "reprehensible."

"If you are pro-life," Johanns said, "you cannot vote to end debate on this bill."

During a telephone interview moments later, Nelson said he believed it's "not appropriate for someone to cast any aspersions on someone else's principles and whether they're pro-life enough."

Nelson said his compromise language ensures that no public funds may be used for abortions and gives states the right to pass a law barring insurance coverage for abortions within state borders.

His language "walls off public money so it may not be used for elective abortions, either directly or indirectly," he said.

National Right to Life rejected the compromise and warned it will consider any votes supporting the bill as "votes in favor of legislation to allow the federal government to subsidize private insurance plans that cover abortion on demand."

The organization said the abortion language is "light years removed" from stricter anti-abortion funding legislation approved by the House.

In announcing he will provide the elusive 60th vote needed to break a Republican filibuster and then cast a vote for the bill, Nelson said the legislation would "reduce cost, expand access and improve health care."

Nelson's announcement followed intensive negotiations with Senate Majority Leader Harry Reid and White House officials.

As the only holdout in the 60-member Democratic caucus, Nelson entered the negotiations with tremendous bargaining power.

"You never get everything you want," he said. "But we did get essentially the things I needed."

The agreement providing full federal funding of expanded Medicaid coverage translates into tens of millions of dollars for Nebraska during the coming decade.

It responds to Republican Gov. Dave Heineman's earlier criticism of a new unfunded federal mandate that would strain the state budget.

Rural health care concessions will mean additional Medicare funding for small hospitals, Nelson said.

And the federal government now will take a new look at the adequacy of Medicare payments to health care providers in rural areas, he said.

While convinced legislation is required to "deliver relief from rising health care costs," Nelson said he would have preferred a more incremental approach, focusing first on cost containment.

Nevertheless, he said, the comprehensive package now being considered by the Senate is needed.

"For the first time," he said, "Americans will not go bankrupt because of health care costs.

"There will no longer be pre-existing conditions, health status ratings, annual or lifetime limits on health insurance coverage.

"And insurance companies will no longer be able to drop coverage just because people get sick."

Nelson said the key to his continued support will be "a limited conference" between the House and Senate to resolve differences in their two bills.

Any material changes could cost Democrats his vote on a later cloture motion that will be required to consider the revised bill, he said.

Reach Don Walton at 473-7248 or at

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