Members of the Senate have started debating whether they ought to debate the Patient Protection and Affordable Care Act bill, and Sens. Blanche Lincoln and Mary Landrieu now say they favor letting the bill come up for discussion.

The Senate plans to hold a cloture vote around 8 p.m. today. PPACA bill supporters need 60 votes to move ahead with debate.

Landrieu, D-La., one of a handful of known health bill swing voters, buoyed supporters shortly after 1 p.m. when she announced that she would vote for starting debate on the bill. But she added that “much more work needs to be done” on the bill before she would consider voting for it.

One step lawmakers ought to take is to improve small business tax credits, especially for businesses with fewer than 25 employers, and to provide tax equity for self-employed individuals who buy their own health coverage, Landrieu said.

Lawmakers also should keep health rates rising excessively between today and the time any proposed changes take effect, and they should limit the amount of exposure taxpayers have to any proposed public option health plan, Landrieu said.

Around 2:30 p.m., Lincon, D-Neb., said she still opposes the idea of a creating a government-run “public option” plan, and may oppose to block further consideration of the bill in the future. “Who pays if [the public option] fails to live up to expectations” and needs a taxpayer bailout, Lincoln asked.

But she said it is important for lawmakers to begin to debate on the bill rather than simply walking away.

“That’s not what the people sent us here to do,” Lincoln said.

Lincoln noted that groups on the left and the right have spent heavily on ads intended to influence her vote, and she reported that individuals from out of state have e-mailed her “unbelievable” threats in connection with the vote.

Sen. Ben Nelson, D-Neb., a third health bill swing voter, announced Friday that he would vote to move ahead with debate on the PPACA bill and try to amend the bill to make it more to his liking.

Senate Majority Leader Harry Reid, D-Nev., unveiled the text of PPACA late Wednesday. The Congressional Budget Office has estimated programs proposed in the bill would cost about $848 billion from 2010 to 2019 but raise enough additional revenue and cut enough spending to save the federal government about $130 billion over that period. The CBO estimates the bill would cut the number of uninsured people to about 24 million, from 54 million if current laws prevail.

FLOOR DEBATE HIGHLIGHTS

Sen. Mark Udall, D-Utah, acknowledged during floor debate on the decision about whether to proceed with debate that PPACA opponents are complaining about the inclusion of a public option provision.

But today, “fewer and fewer people can get insurance,” Udall said. “Where are these people ending up? Medicaid, if they’re poor enough. Or in the emergency room getting uncompensated care.”

Insured Americans already pay for most of that uncompensated care, either through tax-supported government programs or by paying more for their own private health insurance and the care they pay for out of their own pockets, Udall said.

The CBO also declined to include estimates of the effects of many PPACA health cost control provisions, such as efforts to improve wellness efforts and provider payment strategies, and that means that effects of the bill could turn out to be better than the Congressional Budget Office has predicted, Udall said.

Sen. Judd Gregg, R-N.H., said Senate Democrats held down the CBO’s estimate of the gross cost of the bill from 2010 to 2019 by implementing tax increases, Medicare cuts, and other revenue raisers and spending cuts immediately, then holding off on spending on new programs.

“They don’t start their programs until 2014,” Gregg said.

During the first 10 years that the proposed PPACA programs were actually in effect, the total 10-year cost would be about $2.5 trillion, Gregg said.

Sen. Sheldon Whitehouse, D-R.I., said the Republicans ran up an $8 trillion “fair weather deficit” under the Bush administration, at a time when the economy was generally strong.

“Now, when we take on the insurance industry, suddenly they discover a concern about deficits,” Whitehouse said.

The insurance companies hate the possibility of the government creating a public health insurance option because they hate the idea of having new competition, Whitehouse said.

Right now, he said, “they love having these huge market shares, to be able to dictate prices.”

On the issue of creating a public option, “it is very hard to find any daylight between the position of the insurance industry and the position of our Republican friends,” Whitehouse said.

Sen Richard Burr, R-N.C., complained that the PPACA bill would exacerbate shifting of public health care costs onto the shoulders of private health plans, and that it would discourage small businesses from subjecting themselves to added health insurance red tape by employing more than 50 people.

Sen. Charles Schumer, D-N.Y., expressed astonishment at Republicans who object to creating a public option health plan for working-age Americans while objecting to any changes in Medicare. “Medicare is a government health plan,” Schumer said.

Republicans in the Senate “will follow the map handed to them by the big insurance companies, ignoring the threat to America’s health care future,” Schumer said. But “our Republican colleagues will not stand in our way. The wind is now at our backs. We will pass this bill.”

Sen. Amy Klobuchar, D-Minn., scoffed at Republican comments that the PPACA bill is too long. She recalled that the Bush administration started out with a 3-page Troubled Asset Relief Program bill. “That didn’t work out that well,” Klobuchar said.

Sen. Robert Bennett, R-Utah, said Democrats were focusing too much in floor debate on stories about Americans facing problems with paying for health care and health insurance, and not enough on effective strategies for helping those Americans.

“We all of us, all 100 of us, realize that something has to be done,” Bennett said.

Sen. John McCain, R-Ariz., said the drafters of PPACA bill made it appear to cut the budget deficit, rather than increase it, by making unrealistic cuts in reimbursement for Medicare providers, such as $8 billion in cuts for hospice care.

“Does anybody really believe we’re going to let these cuts take place?” McCain asked. “We’re not, because we’re a loving, caring nation.”

But that means the real cost of the bill is much higher than the Democrats have acknowledged, McCain said.

More information about the PPACA bill is here.