By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Saturday, December 19, 2009; 9:41 AM

Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, was prepared to announce to his caucus Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas.

"We're there," said Sen. Kent Conrad (D-N.D.), as he headed into a special meeting to announce the deal.

Democratic leaders spent days trying to hammer out a deal with Nelson, and worked late Friday night with Nelson on abortion coverage language that had proved the major stumbling block. But Nelson also secured other favors for his home state.

Asked if he was prepared to support the bill, Nelson said, "Yeah."

With Nelson seemingly on board, Senate Majority Leader Harry M. Reid unveiled the final version of a sweeping overhaul of the nation's health insurance system that would expand coverage to an additional 31 million Americans, coming closer to attaining the Democrats' longsought goal of universal medical coverage.

The package closely tracks the $848 billion measure Reid (D-Nev.) drafted this month, before he entered into negotiations aimed at winning the 60 votes he needs to avert a GOP filibuster, aides said. Since then, Reid has made numerous concessions to moderate Democrats, scrapping an effort to create a government-run insurance plan and beefing up prohibitions on spending federal funds for abortion coverage, a change demanded by the final holdout, Sen. Ben Nelson of Nebraska.

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid's package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers.

Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid's package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.

The overall cost of the package was not immediately available, but aides said it would be more than covered by cutting future Medicare spending and raising taxes in the health sector, including a 40 percent excise on the most expensive insurance policies. The package would reduce budget deficits by $130 billion by 2019, aides said, and by as much as $650 billion in the decade thereafter.

Reid officially filed the package early Saturday with plans to hold a first critical vote after midnight Sunday. Barring unexpected delays, Democrats were still hoping to push the package to final passage by Christmas Eve.