WASHINGTON — A year in the making, sweeping health care legislation backed by President Barack Obama hung in the balance Thursday as conservative Democratic Sen. Ben Nelson withheld his vote in pursuit of stricter abortion limits and liberals grew restive on the left.
Any lingering hopes the bill's supporters had of a Republican casting a critical 60th vote vanished when Sen. Olympia Snowe, R-Maine, said after a meeting with Obama that the Democrats' timetable for a pre-Christmas vote was "totally unrealistic."
Nelson, the most conservative Democrat in the Senate, was vague throughout the day about his intentions, eventually telling reporters, "I hope we're getting closer" to agreement.
"Without modifications, the language concerning abortion is not sufficient," he said earlier in the day in a written statement that summarized the results of days of private negotiations. The second-term Nebraskan opposes the procedure and wants tighter restrictions written into the overhaul.
With Nelson's support, the White House and Senate Democrats would command 60 votes for the health care measure, enough to overcome a Republican filibuster and pass the bill within a matter of days.
Without it, the prospects are far more uncertain, given unyielding Republican opposition on the conservative right as well as growing expressions of unhappiness on the left that sent the White House scrambling.
"The absolute refusal of Republicans in the Senate to support health care reform and the hijacking of the bill by defenders of the insurance industry have brought us a Senate bill that is inadequate," Richard Trumka, head of the AFL-CIO, said in a statement.
His criticism of GOP lawmakers aside, Trumka's blast seemed aimed at Nelson, Joe Lieberman, I-Conn., and possibly other members of the Senate Democratic caucus who have successfully stripped the legislation of any form of government-run insurance option.
Andrew Stern, head of the Service Employees International Union, said he, too, was deeply disappointed in the bill.
But like Trumka, he stopped short of urging its defeat. Not so Howard Dean, the former national party chairman, who has said he would oppose the legislation because it does not include a strong enough role for the government in a remade health care system. Dean unleashed his criticism this week after Lieberman won the deletion of a proposed expansion of Medicare from the bill.
Overall, the legislation is designed to extend coverage to millions who lack it, ban insurance company practices such as denying coverage because of pre-existing conditions and slow the rise in medical spending nationwide.
The bill would require most Americans to purchase insurance, and it includes hundreds of billions of dollars in subsidies to help lower- and middle-class families afford it.
The White House dispatched strategist David Axelrod to answer liberal critics in television interviews. Former President Bill Clinton, who failed to win a health care overhaul in the 1990s, issued a statement saying, "Allowing this effort to fall short now would be a colossal blunder, both politically for our party and, far more important, for the physical, fiscal, and economic health of our country."
Liberal supporters of the measure in the Senate renewed their support, as well. Sen. Tom Harkin, D-Iowa, said debates "leading to the passage of Social Security in 1935 and Medicare in 1965 were no less turbulent and partisan." In the current case, he added, "We have had to make painful compromises," but he predicted what will be remembered is that "President Obama achieved his No. 1 domestic priority and that Congress passed a big, historic bill."
Perhaps, but not yet.
Abortion wasn't the only issue Thursday, just the one commanding the most public attention.
Sen. Amy Klobuchar, D-Minn., a supporter of the legislation, said she was involved in talks to cushion the impact on nonprofit insurance companies from the effects of a new industrywide tax. She also sought to ease the effects on small businesses from the tax on medical device makers.
While Nelson sent somewhat conflicting signals during the day, the anti-abortion Catholic Health Association issued an unambiguously optimistic statement on the compromise talks to date on the issue.
"Especially now that a public health insurance option is no longer on the table, we are increasingly confident that Senator Casey's language can achieve the objective of no federal funding for abortion," said Carol Keehan, the group's president and chief executive officer. "We look forward to reviewing the final language these improvements contemplate."
Sen. Bob Casey, a Pennsylvania Democrat with strong anti-abortion credentials, has been leading efforts to find a compromise that could win Nelson's support without jeopardizing the bill's support among lawmakers on the other side.
Nelson, in an interview with KLIN radio in his home state, he said he was dissatisfied with a proposed compromise on abortion and cast doubt on whether there was still time to complete work on the legislation before Christmas, the informal deadline set by the Democratic leadership.
He also said abortion wasn't his only concern.
"That's not enough," he said, adding that the bill's proposed expansion of Medicaid could wind up costing his state money.
A few hours later, his office issued a more tempered written statement, noting that the proposal included "important new initiatives addressing teen pregnancy and tax credits to help with adoptions." It did not speculate about whether the bill might pass by Christmas.
A draft of the proposal also would permit consumers to opt out of abortion coverage, and require insurance companies to cut premiums for those who do.
Abortion played a similar, critical role last month in the final stages of the House debate.
There, abortion foes succeeded in winning significantly strengthened restrictions in the legislation.
Nelson, backed by the U.S. Conference of Catholic Bishops and others, is now out to accomplish the same mission.
As drafted, the measure bans the use of federal funds to finance abortions under insurance to be sold in a newly created exchange, except in cases of rape, incest or danger to the life of the mother. The plans could provide abortion coverage, however, that consumers would purchase with their own money held apart from any federal subsidies they receive.
That approach draws criticism from abortion opponents who argue it is an accounting gimmick.
Associated Press writers Ricardo Alonso-Zaldivar and Erica Werner contributed to this report.