Lawmakers who attended a private meeting between Mr. Obama and Senate Democrats at the White House on Tuesday pointed to remarks there by Senator Evan Bayh, Democrat of Indiana, as providing some new inspiration.
Mr. Bayh said that the health care measure was the kind of public policy he had come to Washington to work on, according to officials who attended the session, and that he did not want to see the satisfied looks on the faces of Republican leaders if they succeeded in blocking the measure.
The measure would extend health benefits by expanding Medicaid and providing subsidies to help moderate-income people buy private insurance. It would require nearly all Americans to obtain health insurance or pay financial penalties for failing to do so.
By redrawing the landscape of the health care sector, the legislation stands to reshape roughly one-sixth of the American economy.
The nonpartisan Congressional Budget Office said the legislation would cost $871 billion over 10 years, with the expense more than offset by revenues from new taxes and fees and by reductions in government spending, particularly in slowing the growth of Medicare.
The budget office said the bill would reduce future deficits by $132 billion over that period. Republicans have accused Democrats of using accounting tricks to hide the true cost of the measure, which they predicted would be huge, particularly if Congress did not follow through on proposed reductions in Medicare.
In place of the public option, the Senate bill would create at least two new national health insurance plans modeled after those offered to federal workers, including members of Congress, and overseen by a federal agency, the Office of Personnel Management. At least one of those new plans would have to operate on a nonprofit basis.
The bill includes a new government-run long-term care insurance program. And it imposes tight new regulations on the health insurance industry, barring insurers from denying coverage based on pre-existing medical conditions and limiting how much extra they can charge people based on their age.
Mr. Reid, racing to complete the bill by his self-imposed holiday deadline, on Saturday morning introduced a 338-page package of last-minute amendments, including the main provisions needed to win Mr. Nelson's support.
Congressional Budget Office Score for the Health Bill
Republicans, who vowed to use every procedural weapon to stop the bill, immediately forced a reading of Mr. Reid's proposal, which was expected to take 10 hours and had to be done by midnight to keep Democrats on track for a final vote on Christmas Eve.
Procedural hurdles still lie ahead, including at least three votes that will require unanimous support by the Democratic caucus. The absence of even one senator could upend the process.
Under the deal worked out with Mr. Nelson, health insurance plans would not be required or forbidden to cover abortions, but states could prohibit the coverage of abortions by plans that are offered for sale through new government-regulated marketplaces.
The amendment also includes, solely for Nebraska, a special extension of increased federal contributions to the cost of an expansion of Medicaid, the state-federal insurance program for the poor.
Mr. Reid introduced his amendment after the Senate easily approved and sent to Mr. Obama a $626 billion military spending bill in an extraordinary session that began before sunrise and reflected the increasingly toxic atmosphere in a chamber that normally prides itself on decorum.
Despite the 88 to 10 vote, the Pentagon bill was the focus of some angry partisanship.
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