Momentum is building for favorable action, but the Senate must still master a delicate balance. Many Senate Democrats want to expand the Senate Finance Committee version to include the public plan and other controversial provisions.
If those get added, Senate centrists, both Democrat and Republican, will withdraw their support. The prospect of Senate Democrats overreaching may be the biggest obstacle to ultimate passage.
In an interesting twist of fate, three of the centrist Senate swing votes are former commissioners of insurance. Let's take a quick snapshot of five key senators who may decide the eventual fate and the shape of health-care reform.
Olympia Snowe and Susan Collins, both R-Maine
Last week, Snowe became the poster girl for bipartisan health reform by being the only Republican to vote with the Democrats in the Senate Finance Committee. She is a third-term senator who was orphaned at age 9 by her mother's cancer and father's heart disease.
She represents a small state whose insurance market is dominated by one large firm. Likewise, her colleague, Collins, is a moderate Republican who joins Snowe in being two of only three Republican senators to vote for the stimulus bill earlier this year.
Collins is a former insurance commissioner. Neither Snowe nor Collins has shown interest in the public plan, but both are key votes, and perhaps the only Republican senators who may vote in favor of health reform.
Sen. Blanche Lincoln, D-Ark.
On the Democratic side, Lincoln is up for re-election next year, and the Arkansas polls show her with approval ratings at an abysmal 36 percent. Since 67 percent of Arkansas opposes the public plan, Lincoln was one of three Democrats to vote against that option in the Senate Finance Committee.
If the Democratic leadership forces her to support health reform, it may come at the cost of a Democratic Senate seat in Arkansas.
Sen. Ben Nelson, D-Neb., and Sen. Bill Nelson, D-Fla.
Similarly, Ben Nelson is a key Democrat from Nebraska. He is also a former state insurance commissioner and a former head of an insurance company. He knows the insurance industry well and is uneasy about federalizing it. He doesn't want to support a public plan and may vote against it. The final Democrat on the bubble is Bill Nelson. He is also a former insurance commissioner. Bill Nelson has received nearly 60,000 calls, letters and e-mails from his Florida constituents opposing health reform.
Congress is on the cusp of a historic occasion, and restraint may now be the key to passing a bill. While significant movement has occurred in the last week, the key voting still lies ahead.
Washington Report: Preserving Homes and Communities ActInsurers say health bill would jack up premiums