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Invoking the memory of Edward M. Kennedy,
Democrats united Saturday night to push historic health care
legislation past a key Senate hurdle over the opposition of
Republicans eager to inflict a punishing defeat on President Barack
Obama. There was not a vote to spare.

      The 60-39 vote cleared the way for a bruising, full-scale debate
beginning after Thanksgiving on the legislation, which is designed
to extend coverage to roughly 31 million who lack it, crack down on
insurance company practices that deny or dilute benefits and
curtail the growth of spending on medical care nationally.

      The spectator galleries were full for the unusual Saturday night
showdown, and applause broke out briefly when the vote was
announced. In a measure of the significance of the moment, senators
sat quietly in their seats, standing only when they were called
upon to vote.

      In the final minutes of a daylong session, Majority Leader Harry
Reid, D-Nev., accused Republicans of trying to stifle a historic
debate the nation 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 of Kentucky, said
the vote was anything but procedural - casting it as a referendum
on the bill itself, which he said would raise taxes, cut Medicare
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 Democratic
holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of
Arkansas, announced they would join in clearing the way for a full
debate.

      "It is clear to me that doing nothing is not an option," said
Landrieu, who won $100 million in the legislation to help her state
pay the costs of health care for the poor.


      Lincoln, who faces a tough re-election next year, said the
evening vote will "mark the beginning of consideration of this
bill by the U.S. Senate, not the end."


      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 nation's health care system in a half-century or
more.

      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 legislation would require most Americans to carry insurance
and provide subsidies to those who couldn't afford it. Large
companies could incur costs if they did not provide coverage to
their workforce. The insurance industry would come under
significant new regulation under the bill, which would first ease
and then ban the practice of denying coverage on the basis of
pre-existing 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.

      The House approved its version of the bill earlier this month on
a near party line vote of 220-215, and Reid has said he wants the
Senate to follow suit by year's end. Timing on any final compromise
was unclear.

      All 58 Senate Democrats and two independents voted to advance
the bill. All 39 votes in opposition were cast by Republicans. GOP
Sen. George Voinovich of Ohio was the only senator not to vote.
Montana Sen. Max Baucus, the chairman of the Senate Finance
Committee who has labored on health care for more than a year, flew
in from his home state on a government plane for the vote and was
returning afterward to be with his ailing mother.

      While timing made Landrieu and Lincoln the final two Democrats
to announce their intentions, Sen. Paul Kirk of Massachusetts had a
clear claim as the 60th vote.

      Appointed to office this fall after the death of Kennedy, who
championed health care issues for decades, Kirk said he spoke for
those "who for so many years revered and loved and elected and
re-elected (him) ... that I think they're all - they all, as we do,
have him in our minds and our hearts tonight. ..."


      Sen. Chris Dodd, D-Conn., echoed those sentiments later in the
evening when he 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.


      In hours of debate before the Saturday evening vote, a few
Republicans piled copies of the 2,074-page bill on their desks
while others criticized it as a government takeover of health care
and worse.


      "Move over, Bernie Madoff. Tip your hat to a trillion-dollar
scam," said Sen. Kit Bond, R-Mo., likening the bill's supporters
to the imprisoned investor who fleeced millions.


      In her remarks, Landrieu said, "I've decided that there are
enough significant reforms and safeguards in this bill to move
forward, but much more work needs to be done." She also touted the
$100 million included in the legislation to help her state cover
its costs under Medicaid, the state-federal health care program for
the poor.


      Lincoln referred repeatedly to the political controversy
surrounding the issue. She said $3.3 million has already been spent
by outside groups advertising either for or against health care
legislation in her state, and said, "these outside groups seem to
think that this is all about my re-election. I simply think they
don't know me very well."


      To finance the expanded coverage, Reid proposed higher taxes as
well as cuts totaling hundreds of billions of dollars in projected
Medicare payments. Hardest hit would be the private insurance
Medicare plans, although providers such as home health agencies
would also receive significantly less in future years than now
estimated.


      The bill raises payroll taxes on incomes over $200,000 for
individuals and $250,000 for couples. Reid eased the impact of an
earlier proposal to tax high-value insurance plans, which has
emerged as one of the principal methods for restraining the growth
in health costs.


      The bill includes tax increases on insurance companies, medical
device makers, patients electing to undergo cosmetic surgery and
drugmakers.

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Invoking the name of Edward M. Kennedy,
Democrats united Saturday night to push historic health care
legislation past a key Senate hurdle over the opposition of
Republicans eager to inflict a punishing defeat on President Barack
Obama. There was not a vote to spare.

Dems nail down 60 votes; health reform marches on

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