Washington (CNN) -- House Democrats are signaling that a final health care bill will drop the government-run public health insurance option favored by liberals but rejected by conservatives from both parties.

A House-Senate conference committee will begin negotiations next month on merging health care bills passed by the Democratic majorities in each chamber.

However, voting in both chambers was extremely close, raising concerns that a compromise might fail to win the necessary final approval.

One of the main differences between the two measures is the public option. The House bill contains the public option as a competitor to private insurers in a national heath insurance exchange open to people now unable to get coverage, but the Senate version lacks a public option.

President Obama, who has made health care reform his top domestic priority this year, has expressed general support for a public option but stops short of insisting on the provision.

Liberal Democrats in the House have said they want to keep the public option, but one of their leaders -- Rep. James Clyburn of South Carolina, the chamber's third-ranking Democrat -- said Sunday that he could vote for a bill without the government insurance plan.

"We want a public option to do basically three things: create more choice for insurers, create more competition for insurance companies and to contain costs," Clyburn said on the CBS program "Face the Nation." "So if we can come up with a process by which these three things can be done, then I'm all for it. Whether or not we label it a public option or not is of no consequence."

The Senate health care bill required the support of all 60 members of the Democratic caucus to overcome a Republican filibuster. Such precarious support allowed individual moderates in the Democratic caucus to wield major influence on the bill, with at least two -- Sens. Joe Lieberman of Connecticut and Ben Nelson of Nebraska -- saying they would oppose the measure if it contained the public option.

On Sunday, Rep. Chris Van Hollen of Maryland, chairman of the Democratic Congressional Campaign Committee, acknowledged the reality of the Senate politics. Asked on "Fox News Sunday" about the public option, Van Hollen said, "It's not dead, but we also recognize that the Senate was able to just muster the 60 votes."

The House could drop the public option if "there are other mechanisms in whatever bill comes out that will keep down premiums," Van Hollen said.

Supporters of a public option say it would provide nonprofit competition to private insurers that would bring down costs, but opponents contend that it is the first step toward a government takeover of the health care system.

In place of a public option, the Senate bill includes a provision allowing private insurers to offer nonprofit coverage overseen by a government agency.

Both the House and Senate bills would permit the creation of nonprofit private insurance cooperatives to increase competition.

(CNN) -- Arguments over the massive overhaul of the health care system -- which congressional Democrats hope to pass by next month -- are expected to keep shaking up the country long after the vote.

Congress' plan could be the first legislation of its kind passed along strict partisan lines. In modern history, legislation of such scope -- including Social Security in 1935 and Medicare in 1965 -- has had at least some support from the opposition.

"The bottom line is that, unlike other major legislation which has passed with more bipartisan support, health care is going to remain a political football, and people are going to have a sense that it is not fully settled yet for a while," said David Gergen, a senior political analyst for CNN who also worked in the Nixon, Ford, Reagan and Clinton administrations.

"It's sign of the unhealthy quality of our politics that a bill this significant in our social history is passing with only one party in favor," he said.

Sarah Binder, an expert on Congress and legislative politics with the Brookings Institution, said that in the past two decades, Republicans and Democrats have become increasingly polarized.

"It just seems that the incentive to disagree seems to be growing," she said.

Because of the ideological polarization, the parties are growing further apart in policy terms, and thus reaching across the aisle is becoming a tougher task, Binder said.

The polarization, coupled with another development in recent history -- partisan team play -- has contributed to the heightened partisan rancor surrounding the health care debate, she said.

Partisan team play is more about keeping a party cohesive and opposed to the other party than it is about underlying policy, she added, comparing this session of Congress to the 103rd, the last time Democrats controlled Congress and the White House. There was a "whole slew of Democratic initiatives in '93-94 where Republicans said, 'We're not going to vote for these,' " Binder said.

Ilona Nickels, a congressional analyst and lecturer, said that with the current health care legislation, there was never much hope for bipartisanship, because the divide between the parties over the role and size of government intervention is "a pre-existing issue."

"Once you grow government to tackle any major societal problem, it is doubtful you would be able to bring any Republicans aboard," she said in an e-mail to CNN.

No Republicans supported the bill passed in the Senate, and the House version received just one Republican vote. Before a final bill can be sent to President Obama's desk, the two versions must be merged into one and voted on again.

Senior Democratic sources say that a traditional House-Senate conference committee is unlikely to meet to work out differences, because that would allow the GOP to slow the progress in the Senate. Democratic leaders from both chambers may instead circumvent the traditional process through informal, high-level talks, the sources said.

Most Americans disapprove of the current health care legislation, according to CNN's most recent polling.

"In addition to the polarization that already exists, there is deep polarization in the country about the bill itself on the merits," Gergen said. "There may be instances, but I can't think of them, when a major piece of domestic legislation has passed in the teeth of public disapproval."

Nickels, who spent several years as a congressional staff aide, pointed to the 1980s for an example of the risks of acting on legislation without public support.

Congress passed the Catastrophic Coverage Act in 1988. The legislation was intended to expand Medicare to protect seniors against catastrophic medical expenses. To pay for it, enrollees saw higher monthly premiums and a surtax. Senior citizens became livid when they fully understood its impact, Nickels said.

Democratic Rep. Dan Rostenkowski of Illinois championed the legislation, which was enacted with the help of the AARP. Nickels recalled that angry voters booed the congressman and pelted his car with eggs. The law was repealed in 1989.

"In the battle of the spin wars to come on the health care bill, no one should underestimate the public's reaction once the impact of the bill's provisions become clearer and, if enacted, actually felt," Nickels said.

Still, it's an important historical win for Obama if he signs the health care bill into law, Gergen said.

"What the White House hope would be is that over time, people would come to appreciate it. People will adjust and find that the benefits of the bill far outweigh the negatives and that it will be a major plus for his party over time. Right now it's not," he added.

Debate over the legislation will play a key role in the upcoming midterm elections, with Democrats pushing its benefits and Republicans slamming its costs.

"It's pretty clear at the moment that unless opinion swings in favor of the bill, as it may, then Republicans will run against the reform in 2010 elections and probably in 2012. And that will present the prospect that over time they can change it," Gergen said, noting that even some Democrats have said they intend to change the bill over time.

But in order for Republicans to make gains at the polls, it would take a "delicate balancing act" since those gains would likely come from independent voters, said Republican strategist Karen Hanretty. Independent voters are fiscally conservative and wary of the massive price tag attached to health care reform, but they also don't like partisanship, she noted.

Anticipating some conservative Democrats losing in this year's congressional elections, Nickels said she thinks the White House is knowingly sacrificing some members of its own party in exchange for what the administration believes will be a seminal accomplishment.

CNN's Dana Bash and Deirdre Walsh contributed to this report.

(CNN) -- If Senate Majority Leader Harry Reid has his way, his chamber will vote Saturday to proceed with debate on its version of the health care bill.

If he's successful, Senate Democrats can breathe a sigh of a relief momentarily -- but it's too early for them to celebrate. The road to final passage of health care legislation is still long and bumpy.

Reid needs 60 votes for the procedural vote this weekend, another 60 votes to close debate -- which could last for weeks -- but only 51 for final passage. Reid has said he hopes to vote on the final bill before the end of the year. President Obama's original deadline for Congress was last August.

The first hurdle appeared to be reached Saturday when Sen. Blanche Lincoln of Arkansas said she will support bringing the Senate health care reform bill to the floor for debate, giving Democrats the 60 votes needed to prevent a Republican filibuster.

The House passed its version of health care reform two weeks ago, with 220 representatives voting in favor and 215 against. Thirty-nine Democrats opposed the plan and one Republican supported it.

But it's a tougher fight for Democrats in the Senate, where it is much easier for the GOP minority to stifle the will of the Democratic majority.

If the Senate does pass a bill, a congressional conference committee will need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to Obama's desk to be signed into law.

Already, Democratic leaders in the House and Senate have reached agreement on a broad range of changes that could affect every American's coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and a plan approved by the Senate Finance Committee would limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers would be barred from charging higher premiums based on a person's gender or medical history.

Medicaid, the government-run health care plan for the poor, would be expanded significantly under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an antitrust exemption that has been in place since the end of World War II.

What are the major differences?

For starters, the House bill is more expansive -- and hence expensive -- than the Senate bill. The House bill, projected to guarantee coverage for 96 percent of Americans, will cost more than $1 trillion over the next 10 years, according to the nonpartisan Congressional Budget Office.

The Senate bill, estimated to cover 94 percent of Americans, comes with an $848 billion price tag, according to the CBO.

One of the biggest divides between House and Senate Democrats is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and new spending constraints in Medicare and Medicaid.

Specifically, individuals with annual incomes over $500,000 -- as well as families earning more than $1 million -- would face a 5.4 percent income tax surcharge.

The Senate measure also trims entitlement programs such as Medicare and Medicaid.

The bill also includes a range of tax increases and new fees. The Medicare payroll tax on individuals earning $200,000 a year and couples earning $250,000 a year would increase by a half-percentage point, from the current 1.45 percent to 1.95 percent.

CNNMoney: Senate tax hike misses the mark

In addition, insurers providing costly health coverage -- known as "Cadillac" plans -- would face a 40 percent tax on premiums of greater than $8,500 for individuals and $23,000 for families. The Senate bill also includes a 5 percent tax on the cost of elective cosmetic surgery, as well as new fees for insurers and pharmaceutical manufacturers. The revenue from all the taxes and fees is projected to exceed $200 billion.

Proponents of the tax on high-end plans argue it's one of the most effective ways to curb medical inflation. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Another key sticking point: the dispute over a government-run public option. Both plans include a public option, but the Senate bill gives individual states until 2014 to decide whether they want to opt out.

Under both plans, individuals would be required to purchase coverage, but the House bill includes more stringent penalties for most of those who fail to comply. The Senate plan would require individuals to buy health insurance, with a fine for noncompliance of $95 in the first year that would escalate to $750 by 2016. Parents would be responsible for providing coverage for children up to age 18.

The House bill would impose a fine of up to 2.5 percent of an individual's income.

Both versions include a hardship exemption for poorer Americans.

Employers also face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Senate bill would require companies with more than 50 employees to pay a fee of up to $750 per worker if its employees rely on government subsidies to purchase coverage.

Abortion also promises to remain a major obstacle for both chambers.

The Senate plan would allow abortion coverage through privately funded premiums in both a government-run public insurance option and private plans purchased with the assistance of government subsidies.

The more conservative House of Representatives plan, in contrast, would bar abortion coverage under both the public option and private policies purchased with government subsidies. House Democratic leaders opposed the measure, but added it to win critical support from anti-abortion members. Both plans would allow for exceptions in cases of rape, incest or when the life of the mother is in danger.

Washington (CNN) -- Traditional Senate decorum yielded to brass-knuckle politicking Friday in the health care debate as top Democrats sought to close party ranks before a key procedural vote this weekend.

Senate Democrats slammed their GOP colleagues as leaders of a counterproductive party of fear caught in an obstructionist mind-set dating back to the New Deal.

In turn, Republicans ripped Democrats for pushing a bill that conservatives say will force millions of Americans to drop insurance plans they like while jacking up premiums and doing nothing to slow spiraling medical costs.

The harsh rhetoric was backdrop for a rare Saturday night Senate vote on whether to proceed formally with floor debate on Senate Majority Leader Harry Reid's sweeping $848 billion health care bill.

The White House issued a statement Friday urging "quick action on this landmark bill.

"This legislation meets the president's criteria for health insurance reform: it provides stability and security to those with insurance; offers access to quality, affordable health care for those who do not have insurance; cuts costs for families, small businesses and the government; and does so without adding a dime to the deficit," the statement from the Executive Office of the President said, without mentioning the president by name.

The U.S. Conference of Catholic Bishops, meanwhile, issued a strongly worded letter Friday to the Senate insisting that body adopt strict limitations on insurance coverage for abortions, as the House of Representatives did two weeks ago.

The bishops called on senators to keep in place "the long-standing and widely supported federal policy against government funding of elective abortions or plans that include elective abortions."

If Republicans stay unified in opposition to the bill, Reid will need the support of all 58 Senate Democrats along with independent Sens. Bernie Sanders of Vermont and Joe Lieberman of Connecticut to reach the 60 votes necessary to overcome a filibuster.

Two key Democratic moderates -- Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas -- have refused to indicate publicly if they'll back Reid. Each has expressed concern about the cost and scope of the legislation.

A third Democrat whose support had been in doubt -- Sen. Ben Nelson of Nebraska -- said Friday he will vote to start debate.

"Throughout my Senate career I have consistently rejected efforts to obstruct," Nelson said in a statement. "That's what [Saturday's] vote ... is all about."

Nelson said his decision should not be construed to mean he ultimately would vote to pass the bill.

"It is only to begin debate and an opportunity to make improvements," he said. "If you don't like a bill, why block your own opportunity to amend it?"

cnn

Senate Dems suggest they're open to altering health care bill

Senate reform moves ahead

Washington (CNN) -- Amid conflicting and heated rhetoric, a political pragmatism began to emerge Sunday as senators prepared for a debate on a sweeping Democratic health care bill.

Senate Democrats barely won a vote Saturday night to open debate on the 2,074-page bill. The debate on amending the proposal is expected to last for weeks and won't begin until after Thanksgiving.

Some legislators got a head start Sunday, reciting well-honed arguments for and against the bill and offering perspectives on the political realities facing Congress.

Sen. Dick Durbin of Illinois, the chamber's second-ranking Democrat, acknowledged he was open to changing the bill's controversial government-run public health insurance option favored by the left.

"We are open because we want to pass the bill," Durbin told the NBC program "Meet the Press."

Sen. Jeanne Shaheen, D-New Hampshire, summed up the situation to CNN's "State of the Union" program: "Listen, in the end, this is going to be a compromise. It's not going to be a perfect bill, but it's going to be a very important starting point."

Sen. Michael Bennet of Colorado, a Democrat appointed last year to fill the seat vacated when Ken Salazar became interior secretary, told CNN he would support the health care bill even if it meant losing his job in his first election for the seat next year.

Republican opponents continued attacking the bill, calling it an unnecessary takeover of the health care system that would harm, not help, the economy and the American people.

"We do not believe completely restructuring one-sixth of our economy is a good idea at any time," Senate Minority Leader Mitch McConnell, R-Kentucky, told CNN. "It is a particularly bad idea when we're looking at double-digit unemployment."

McConnell and other Republicans call for an incremental approach that they say would reduce the costs of health care without creating new bureaucracy and taxes.

"We think we ought to go step-by-step to improve the system," McConnell said. "The American people are not complaining about the quality of health care. They're complaining about the cost of health care."

Democrats respond that the Republicans are ignoring millions of Americans who can't get health insurance.

Sen. Arlen Specter, a Pennsylvania Democrat who was a Republican for most of his long career until changing parties this year, told "Fox News Sunday": "The one option which is not present in my judgment is the option of doing nothing."

"We have the opposition refusing to admit that there's any problem with health care, refusing to admit that there's any problem with global warming, refusing to take a stand on the economic crisis," Specter complained about his former party.

The 60-39 Senate vote Saturday to open debate revealed the partisan divide on the issue, and the fragility of the Democratic support. Democrats needed their entire caucus, including two independents, to muster the 60 votes required in the 100-member chamber to overcome a Republican filibuster. Share your thoughts on health care reform

Now several conservative and moderate Democrats say they won't support a final bill that includes a public insurance option. Republicans unanimously oppose the public option, which means it cannot survive in the chamber without unanimous Democratic support.

"I don't think anybody feels this bill will pass" in its current form, Independent Sen. Joe Lieberman of Connecticut told NBC's "Meet the Press." Lieberman voted to start debate on the bill, but reiterated Sunday he would join a Republican filibuster if the public option remains in the proposal when it comes time to end the debate.

He called the public option a "radical departure" from the government regulation and litigation traditionally used to deal with failed competition in the U.S. market economy.

Other risky issues for Democrats include abortion and tax increases to pay for health care reform. A comic moment occurred when Republican Sen. Jon Kyl of Arizona and Democratic Sen. Charles Schumer of New York responded simultaneously when asked on the CBS program "Face the Nation" if the Senate bill would raise taxes, Kyl saying "yes" and Schumer saying "no."

The bill includes tax increases aimed at those earning more than $200,000 a year and insurers providing "Cadillac" health plans worth more than $8,500 a year for individuals or $23,000 for families. It also would set a 5 percent tax on elective cosmetic surgery.

In contrast, a separate health care bill that the House of Representatives narrowly passed this month includes an income tax surcharge on individuals earning more than $500,000 a year and couples making more than $1 million.

Republicans say any tax increase is bad in a struggling economy because it hinders growth and gets passed on to consumers. Democrats argue the bill's tax provisions don't hit the lower or middle class and will create incentives for private insurers to lower the cost of policies.

On abortion, the House bill has more restrictive language regarding the use of federal funding, and some Senate Democrats said Sunday they would resist adding it to their chamber's proposal.

"We shouldn't be using health care reform to rewrite long-standing policy from the federal government on abortion," Bennet said on CNN. "It's just not right. It's not the place we should be doing it."

If the Senate manages to pass a bill, a congressional conference committee will then need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to President Obama's desk to be signed into law.

According to the nonpartisan Congressional Budget Office, the Senate health care bill would extend health coverage to 31 million additional Americans and reduce the federal deficit by about $130 billion over the next 10 years, through 2019. Any effect on the deficit in the following decade would be "subject to substantial uncertainty," but probably would result in "small reductions in federal budget deficits," the CBO report said.

Both the Senate and House bills would require individuals to buy health insurance, with penalties for non-compliance. Unlike the House version, the Senate bill does not mandate that all employers offer health care.

The two bills are virtually identical on a broad range of changes, including creating health insurance exchanges, expanding Medicaid, subsidizing insurance for low- and some middle-income families, and capping out-of-pocket medical expenses, while preventing insurance companies from denying coverage for pre-existing conditions.