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Steven R. Hurst Associated Press Writer
Published: 23 November 2009

WASHINGTON (AP) -- Senate Democrats, without a vote to spare, have pushed forward a bill to overhaul the U.S. health care system, but a divisive debate still lies ahead and there is no assurance the measure -- as written -- will win approval in the upper chamber of the Congress.
In a rare weekend session, the Senate voted 60-39 to move the health care reform legislation to the floor for a full debate, expected to begin after lawmakers return from the Thanksgiving holiday recess. The 60 votes -- a three-fifths majority -- were the minimum needed under Senate rules to overcome Republican legislative maneuvers to prevent the bill from even being debated by the full Senate.
All 58 Senate Democrats and two independents voted to advance the bill. Republican Sen. George Voinovich of Ohio was the only senator not to vote.
The legislation would extend coverage to roughly 31 million Americans without health insurance, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.
The United States, with a population exceeding 300 million, is the only developed nation that does not have a comprehensive national health care plan. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers.
The House of Representatives approved its version of the bill earlier this month on a near party line vote of 220-215. Senate majority Leader Harry Reid, a Democrat, has said he wants the Senate to pass the measure by year's end. From there, the Senate and House bills would go to what is known as a conference committee where selected members of each chamber would meld the two versions of the overhaul legislation. Each house would then need to approve the final bill before it could be sent to President Barack Obama for his signature.
The president has made revamping health care the key plank in his domestic policy agenda, and Republicans have been fighting to block passage. They believe a defeat on the issue could cripple the administration early in Obama's first term.
In the final minutes of a daylong session, Reid accused Republicans of trying to stifle a historic debate the country needed.
"Imagine if, instead of debating whether to abolish slavery, instead of debating whether giving women and minorities the right to vote, those who disagreed had muted discussion and killed any vote," he said.
The Republican leader, Sen. Mitch McConnell, said the vote was anything but procedural -- casting it as a referendum on the bill itself, which he said would raise taxes, cut the government's Medicare insurance program for the elderly, and create a "massive and unsustainable debt."
For all the drama, the result of the Saturday night showdown had been sealed a few hours earlier, when two final moderate Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate.
Both stressed they were not committing in advance to vote for the bill that ultimately emerges from next month's debate.
Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval -- a part of Reid's bill expected to come under significant pressure as the debate unfolds.
Even so, their announcements marked a major victory for Reid and the White House in a year-end drive to enact the most sweeping changes to the U.S. health care system in a half-century or more. President Bill Clinton's push for health care reform in the 1990s faltered much earlier in the legislative process.
At the White House, press secretary Robert Gibbs issued a statement saying the president was gratified by the vote, which he says "brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it."
The Senate legislation would require most Americans to carry insurance and provide subsidies to those who could not afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage to those with preexisting medical conditions.
Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.
At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.
To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments.
During the debate, Senate Democrats invoked the memory of Sen. Edward M. Kennedy, who died in August.
Sen. Chris Dodd of Connecticut referred to Kennedy's "lifelong quest" for national health care and said "tonight and in the days to come we will pay him the highest compliment by fulfilling that" goal.
At a post-vote news conference, Reid said he had talked with Kennedy's widow, Vicki, about the vote. "We both said Ted would be happy," Reid said.

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