Nov. 2 (Bloomberg) -- After months of private wrangling, the fight over legislation to revamp the U.S. health-care system will soon spill onto the House and Senate floors.

House Speaker Nancy Pelosi will seek a vote as early as this week while trying to pacify fellow Democrats who say her bill isn’t strong enough and others who fret that federal dollars might be used for abortions. Senate Majority Leader Harry Reid is waiting for cost estimates on his proposals while trying to win enough votes just to start debate.

Both top Democrats are moving legislation closer to the political center of their party, cutting the overall cost and choosing a watered-down version of a government-run health insurance program. They may have to bend even further to get enough votes for passage, especially in the Senate.

“Obviously, they play a key role -- the centrist Democrats,” Maine Senator Olympia Snowe, the only Republican in either chamber who has voted for a congressional health-care bill, told reporters. “I am working with them any way I can.”

Lawmakers are trying to craft a bill that would cover tens of millions of uninsured Americans while curbing medical costs. Their proposals for purchasing exchanges, government subsidies and a requirement that all Americans have insurance represent the biggest changes to U.S. health care in four decades.

Lacking Votes

Reid already lacks the votes for a government insurance program, or public option. He’s struggling to keep all 60 votes controlled by Democrats together on a motion to begin debate and would need 60 again to bring the measure to a final vote.

Reid lost Snowe’s backing when he chose to support a public option. Connecticut Senator Joe Lieberman, an independent who is aligned with the Democrats, also said he would oppose the plan, and four other Senate Democrats -- Kent Conrad of North Dakota, Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana -- have been critical of the idea.

Snowe would vote for a plan that set up a public option only if health-insurance premiums weren’t deemed affordable enough after a certain period of time. That so-called trigger has support among holdouts including Nelson and Landrieu, and President Barack Obama’s administration has signaled an openness to it.

“Senator Snowe has talked a lot about a trigger, and I think she should be listened to,” Landrieu told reporters.

House Fights

In the House, Michigan Democrat Bart Stupak has contended that 40 members would remain united to block legislation unless the abortion issue is resolved or they are given a chance to introduce an amendment during floor debate. Leaders of the 82- member Congressional Progressive Caucus are pushing for a stronger version of the public option.

The progressives support Pelosi’s original plan for a public option with reimbursement rates tied to the lower levels paid by the Medicare program for the elderly. Pelosi had to compromise, faced with opposition from other members, including those in the fiscally conservative Blue Dog Coalition.

Reid’s version of the program is similar to Pelosi’s, though it would allow states to opt out. Besides Snowe’s trigger idea, lawmakers are also considering compromises such as allowing individual states to decide whether to set up a public option.

Nelson told reporters he’s undecided about whether to vote for debate to start and said he would have a hard time backing a bid to call a final vote on Reid’s proposal.

“It would be very difficult for me to vote for that provision,” Nelson said.

Reid has been melding legislation passed by the Senate health committee in July with an $829 billion plan approved by the finance panel on Oct. 13. The health panel included a public option; the finance committee rejected it.

Bill Costs

House lawmakers are considering legislation that would cost $1.055 trillion over 10 years, according to a Congressional Budget Office estimate. Pelosi’s office says the price tag is $894 billion, a net figure that takes into account new revenue such as penalties for not buying insurance.

The House bill now contains fees on medical-device makers, similar to those under consideration in the Senate. Proposals in both the Senate and House would study ways to fix the Medicare payment system and both have long included provisions to encourage greater use of preventive care.

For the most part, the House and Senate have different ways to pay for their legislation. The House depends mostly on a surtax for couples who make more than $1 million a year. The Senate would tax insurers on high-end plans.

And while the House requires that employers with payrolls above $500,000 provide coverage to workers, the Senate would penalize only companies whose employees don’t get coverage through work and then qualify for a subsidy to buy a policy.

If both the House and Senate pass legislation, they will work together on a compromise. And once again leaders will probably turn to a small group of influential lawmakers, said Mark McClellan, a Bloomberg Television contributor and the former head of the Centers for Medicare and Medicaid Services.

“The key factor here is the moderates,” he said.

To contact the reporters on this story: Kristin Jensen in Washington at kjensen@bloomberg.net; Laura Litvan in Washington at llitvan@bloomberg.net

Last Updated: November 2, 2009 00:01 EST