One provision of the health care legislation with broad potential impact on Americans isn't about health insurance. Instead, it would create a new federal long-term care benefit that would pay cash to people who become disabled.

Premiums for the program would be automatically deducted from the paychecks of people who work for participating employers, but employees would have the choice to opt out. Payouts would go only to those who had paid premiums for at least five years.

The long-term care program is in the House bill. But it is not yet clear if it will be in the Senate bill being shaped by Majority Leader Harry Reid of Nevada. Democratic centrists such as Budget Committee Chairman Sen. Kent Conrad of North Dakota have warned the program could add to the deficit. Proponents say it would fund itself.

Leaders of the Senate health committee are pushing for the program partly as a legacy of the panel's former chairman, the late Sen. Edward Kennedy of Massachusetts. The Obama administration has endorsed it.

. . . However, Sen. Conrad and six other Democratic centrists expressed concern about "large, long-term spending increases that far exceed revenues."

"It is unsustainable," said Frank Keating, the former Oklahoma governor who is chief executive of the American Council of Life Insurers. The lobbying group, which has members that sell long-term care insurance, points to an analysis by the American Academy of Actuaries that said the program would likely draw a heavy proportion of participants with health conditions, while healthier people opted out.

The program's backers say the legislation would require it to be "actuarially sound." To assuage budget concerns, the version in a Senate bill could include new language barring taxpayer money from being used to fund the benefit.

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