Pat Dollard

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WASHINGTON (AP) – Senate Democrats on Wednesday took the first major step toward a sweeping overhaul of the health care system in over a decade, pushing legislation despite strenuous GOP opposition and uncertainty about its provisions and costs.

“This is about as historic as it gets for all of us,” said Sen. Christopher Dodd, D-Conn., who is overseeing the proceedings in place of Sen. Edward M. Kennedy, D-Mass., who is battling brain cancer.

The Senate Health, Education, Labor and Pensions Committee began work on a bill encompassing President Barack Obama’s top legislative priority. The effort marked the first time since President Bill Clinton’s administration in the early 1990s that Congress was tackling such a broad overhaul.

Clinton’s initiative failed and the latest attempt has hardly been smooth. Underscoring the difficulty was word Wednesday that the Senate Finance Committee, which has been promising to produce a bill for months, has been forced to delay its deliberations on a measure until after Congress’ July 4th recess.

Senate Finance received an initial high cost estimate of $1.6 trillion and Sen. Kent Conrad, D-N.D., said lawmakers were looking to trim planned subsidies for the uninsured.

Senate Finance Committee Chairman Max Baucus, D-Mont., would only say: “We’ll be ready when we’re ready, but we’re not there yet.”

The Finance Committee, which oversees taxes, is comprised of more moderate lawmakers than Kennedy’s panel and is considered Congress’ best hope of producing a bipartisan bill.

The measure before Kennedy’s committee would cost about $1 trillion over 10 years, but leave 37 million people uninsured, according to an analysis from the nonpartisan Congressional Budget Office.

Sen. John McCain, R-Ariz., last year’s GOP presidential nominee, questioned how the committee could move ahead on legislation without hard figures on cost.

“How can we possibly, reasonably address this bill … without accounting how to pay for it?” McCain asked at the start of the committee’s session. McCain said it was “a joke if we run through this stack of papers.”

Dodd answered that the budget office had provided numbers on some elements and the committee would produce legislation that will be paid for.

High costs, uneven health care and nearly 50 million Americans uninsured have created the strongest political momentum for remaking the system in decades.

“No issue is more of a moral imperative,” Dodd said. “In the richest nation on the face of this Earth, you shouldn’t have to be well-off to get well.”

Senate Republican leader Mitch McConnell of Kentucky, speaking in the full Senate, complained that lawmakers are being pressed to approve the measure without review or knowledge of the costs, just like the stimulus bill.

“Once again it’s rush and spend and rush and spend and a tidal wave of debt,” McConnell said.

Big holes remain on the most contentious issues in Kennedy’s 600-plus-page bill: a new public insurance plan to compete with the private market, and whether employers must provide health care for their workers.

The committee was scheduled to meet daily through next week. There were 388 amendments to be considered, the vast majority from Republicans.

Majority Democrats in the House could make their bill public this week, with committee votes after Congress returns from its July 4 recess.

Major cuts in Medicare and Medicaid will pay for some of the new costs but senators disagreed among themselves over whether to tax employer-provided health benefits—something Obama campaigned against. Also elusive was a compromise with Republicans on a new public insurance plan, which the GOP opposes.

The emerging bills envision a new insurance market “exchange” where people could go to shop for insurance coverage, helped by federal subsidies. Individuals will almost certainly be required to obtain coverage.

In Chicago, the American Medical Association declined to take a firm position on Obama’s proposal to create a public health insurance program to compete with private plans.

The AMA delegates meeting in Chicago agreed Wednesday to support health care reform alternatives that are “consistent with AMA principles,” which include freedom to choose health insurance and universal access for patients. But they didn’t specifically support a plan for public health insurance.

Obama had addressed the organization on Monday.