Senate Panel Clears Health Bill With One G.O.P. Vote

WASHINGTON — The Senate Finance Committee voted on Tuesday to approve legislation that would reshape the American health care system and provide subsidies to help millions of people buy insurance, as Senator Olympia J. Snowe, Republican of Maine, joined all 13 Democrats on the panel in support of the landmark bill.

The vote was 14 to 9, with all of the other Republicans opposed.

Democrats, including President Obama, had courted Ms. Snowe’s vote, hoping that she would break with the Republican Party leadership and provide at least a veneer of bipartisanship to the bill, which Mr. Obama has declared his top domestic priority. Ms. Snowe was a main author of the bill but she had never committed to voting for it.

But shortly after 1 p.m., she announced that she was on board, in a speech that silenced the packed committee room and riveted colleagues on both sides of the dais.

“Is this bill all that I would want?” Ms. Snowe asked. “Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.”

In her speech, she said she still shared many of her Republican colleagues’ reservations about the legislation, and she pointedly warned Democrats that they could easily lose her support at any of the many legislative steps that still lie ahead.

“My vote today is my vote today,” she said. “It doesn’t forecast what my vote will be tomorrow.”

President Obama was quick to praise Ms. Snow for her decision to support the measure. “I think not only Chairman Baucus and others,” he said, “but in particular Senator Snowe has been extraordinarily diligent in working together so that we can reduce cost of health care, make sure that people who don’t have it are covered, make sure that people who do have insurance have more security and stability, and that over the long run we’re saving families, businesses, and our government money.”

Before and after Ms. Snowe’s speech, senators on the panel engaged in heated debate, with Democrats asserting that the bill would set the nation on more sound fiscal footing, and Republicans countering that it would dangerously expand the federal government.

“All Americans should have access to affordable quality health care coverage,” the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, said in opening remarks. “Now is the time to get this done.”

The committee’s top Republican, Senator Charles E. Grassley of Iowa, said that he would oppose the legislation. “This bill is already moving on a slippery slope toward more government control of health care,” he said.

The Finance Committee’s deliberations offered a small preview of what is certain to be a rollicking, impassioned and highly politicized debate on the far grander stage of the Senate floor, where Democrats hold a 60-to-40 majority.

It has been many decades since Congress tried such far-reaching legislation — the health care bill would affect every single American and would reshape the $2.5 trillion-a-year health care industry, representing one-sixth of the nation’s economy.

Because Democrats hold a 13-to-10 majority on the committee, the outcome of the vote was never in doubt. The majority leader, Harry Reid of Nevada, had already announced that the full Senate would take up the health care legislation later this month.

On Wednesday, Mr. Reid plans to meet with Senator Baucus, Senator Christopher J. Dodd, the Connecticut Democrat who was acting chairman of the health committee when it passed its version of the bill and representatives from the White House to begin to meld the Finance Committee bill with the alternate version approved in July.

A spokesman for Mr. Reid, said that Ms. Snowe would also be invited to future sessions, adding that the Democratic leader “is prepared to do what he can to keep her on board while putting together a bill that can get the 60 votes necessary to overcome a Republican filibuster.”

With its vote a little before 3 p.m., the Finance Committee became the fifth Congressional panel to report out a sweeping health care bill.

In the House, the speaker, Nancy Pelosi, is working to combine three measures into one. And in the Senate, Mr. Reid must combine the Finance Committee bill with an alternate version approved by the health committee in July.

The bill seeks to provide health benefits to a majority of uninsured by expanding Medicaid, the federal-state insurance program for the poor, and creating new state-run insurance options for individuals and families earning less than 200 percent of the federal poverty level or $44,100 for a family of four.

For many other moderate-income Americans, the bill would provide government subsidies to help them buy insurance through new government-regulated marketplaces.

The legislation also seeks to impose strict new regulations on the insurance industry, including banning insurers from denying coverage based on pre-existing conditions, and it would require nearly all Americans to obtain coverage.

According to an analysis by the nonpartisan Congressional Budget Office, the Finance Committee bill over 10 years would reduce the number of uninsured Americans by 29 million.

It would still leave 25 million people uninsured, about one-third of them illegal immigrants.

The bill is projected to cost $829 billion over the 10 years, which would be fully offset by new tax and fees, including a tax on high-cost insurance policies, as well as by savings from slowing the growth in Medicare spending by the government.

Democrats and Republicans argued loudly over the fiscal implications of the bill, which the budget office has predicted will reduce federal deficits by $81 billion over 10 years.

Republicans said the bill would cost more than anyone expects, and eventually drive the nation further into debt.

But in a rare moment of comity, Mr. Grassley, who participated in months of negotiations with Mr. Baucus before announcing he could not back the emerging legislation, offered some praise for the bill.

“There is a lot in this bill — it’s not a case of Republican or Democrat or bipartisan,” Mr. Grassley said. “There is just a consensus that it needs to get done.”

After the vote, Mr. Grassley noted: “A vote against the bill is not a vote for status quo. Everybody knows that things need to be changed in our health care system. It’s, how do you do it?”

The main focus of attention, however, was Ms. Snowe, who initially did not give any hint of how she would vote, but instead used her first comments to question the director of the budget office, Douglas W. Elmendorf.

Ms. Snowe’s questioning reflected her concern that changes would be made to the bill that would increase its overall cost.

Ms. Snowe noted that in melding the Finance Committee bill with the health committee measure, legislative language still needed to be drafted, which could lead to surprises.

“I would hope that we could maintain the integrity of the score of this package,” Ms. Snowe said, referring to the cost analysis by the nonpartisan budget office.

In response, Mr. Elemendorf acknowledged that there was always a risk that the drafting would not reflect precisely the intentions of lawmakers or the specifications anticipated by the budget office in its analysis.

Mr. Baucus quickly reassured Ms. Snowe that he was committed to avoiding any misinterpretations or other changes that would alter the cost projections.

One after another, senators voiced their support or opposition to the health care legislation.

Several Democrats used the opportunity to attack a report commissioned by the insurance industry showing the health premiums would rise sharply if the legislation is adopted.

“The misleading and to me harmful claims made over the weekend by the profit-driven health insurance companies are politicking for corporate gain at its worst,” said Senator John D. Rockefeller IV, Democrat of West Virginia.

Senator Orrin G. Hatch, Republican of Utah, complained that the Finance Committee’s vote was virtually meaningless because the bill would be changed later.

“The real bill is currently being written behind closed doors in the dark corners of the Capitol,” Mr. Hatch said, echoing a sentiment shared by other Republicans.

Democrats, however, were not just worried about securing Ms. Snowe’s support, but also the votes of a number of centrist lawmakers in their own party, especially fiscal conservatives worried about the cost of the legislation.