WASHINGTON - Democrats worked to smooth the impact of sweeping health-care legislation on working-class families last night as they pushed President Obama's top domestic priority toward a crucial Senate advance.
The most far-reaching overhaul in decades aims to protect millions who have unreliable coverage or none and to curb insurance company abuses.
Republicans attacked the bill as riddled with tax hikes that violated Mr. Obama's campaign promises, but failed to remove any of them.
After marathon public debate, agreement by the Senate Finance Committee is all but certain for the legislation, though no final vote is expected until next week. That formality - Democrats hold a 13-10 committee majority - will clear the way for the full Senate to begin debating the measure at midmonth.
The measure, like a companion bill in the House, would bar insurance companies from denying coverage or charging higher premiums on the basis of pre-existing medical conditions. It also includes federal subsidies to make insurance available to millions who lack it.
Supporters said the overhaul's cost was in the range that Mr. Obama has set, about $900 billion over a decade, and would not raise federal deficits.
Health-care concerns have grown to dwarf all others in Congress and are causing supporters and opponents to spend more than $1 million a day on TV ads to sway the outcome.
After days spent largely turning aside Republican calls for changes in the bill, Senate Democrats coalesced behind two of their own that could alter the legislation significantly.
One, backed by Sen. Maria Cantwell (D., Wash.), would allow states to negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid, the government health-care program for the poor. That change was approved.
Approval was deferred on a second, which would exempt millions from a requirement to buy insurance that is currently in the bill.
As it stands, individuals and families would be required to buy coverage as long as it cost no more than 10 percent of their income and would have to pay a penalty if they refused.
The Cantwell proposal is based on a system in Washington state that she said results in lower-cost, high-quality coverage, generally delivered through managed care, as the state uses its purchasing power in negotiations with insurers.