Senate Democrats vote to bring health bill to floor for debate

After days of indecision, the last two Democratic holdouts -- Sens. Blanche Lincoln (Ark.) and Mary Landrieu (La.) -- joined their caucus in supporting a motion to begin debate. The 60 to 39 vote marks a milestone in the decades-old quest for health-care reform, President Obama's top legislative priority.

"The road to this point has been started many times," Senate Majority Leader Harry M. Reid (D-Nev.) said before the vote. "It has never been completed."

The debate is expected to last weeks. Reid is aiming for final passage by Christmas.

The House passed a $1 trillion health bill two weeks ago; the $848 billion Senate version represents the work of two committees and hundreds of hours of hearings and deliberations, against a backdrop of fervent Republican opposition. But even as Democrats heralded their victory, they conceded that it represented the end of the beginning -- and not the other way around.

Like Sen. Ben Nelson (D-Neb.), a holdout until Friday, Lincoln and Landrieu said they will press Reid for further changes to the bill before committing to its final passage. Above all, the Democratic caucus remains bitterly divided over a government-run insurance option.

Reid quelled an uprising by liberal senators weeks ago by adding a public option to the legislation. But although he included an opt-out clause for states, some moderates -- including Landrieu and Lincoln -- have told Reid they will oppose the Senate bill on final passage unless the provision is dropped.

"My vote should in no way be construed by the supporters of this current framework as an indication of how I might vote on the final bill," said Landrieu, adding that she also will seek more generous tax credits for small-business health care.

For Democratic leaders, the weeks ahead are likely to bring additional concessions. Lawmakers are already requesting changes to the legislation, raising concerns related to Medicare, abortion and employer requirements.

To secure support for Saturday's vote, Reid had to agree to a 72-hour review period that Lincoln sought after the bill was introduced Wednesday night. He added a Medicaid clause worth up to $300 million for Landrieu's home state. Although many Democrats pressed Reid to include language to end a federal antitrust exemption for health insurers, he omitted the repeal to lock down Nelson's vote.

Republicans portrayed the vote as tantamount to an endorsement of the underlying bill, or "a vote for higher premiums, cuts to Medicare, and more taxes," as Sen. Lamar Alexander (Tenn.) declared.

"All those people who are concerned about the high cost of health care today aren't getting relief under the Democrat plan," said Sen. John Thune (S.D.). "In fact, their lives are going to get much, much worse."