Senate Democrats are poised to pass a landmark health care bill that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.
Ahead lie complex talks with the House to reach final legislation in the new year.
"We stand on the doorstep of history," said Senate Majority Leader Harry Reid, D-Nev. "We recognize that, but much more importantly, we stand so close to making so many individual lives better."
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After 24 consecutive days of debate — the second-longest such stretch ever — the final vote on the Democrats' 10-year, nearly $1 trillion bill is set for early Thursday, Christmas Eve morning. It will be the Senate's first Christmas Eve vote since 1895, when the matter at hand was a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.
Democrats have demonstrated their hard-won unity by clearing three 60-vote procedural hurdles this week, the last one Wednesday afternoon, with all 58 Democrats and two independents holding together against unanimous GOP opposition.
Final passage, requiring a simple majority, is assured. The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.
"We will always remember this day," said Sen. Christopher Dodd, D-Conn.
Negotiations with the House probably will stretch into February, but though the two chambers differ on tricky issues like abortion and the reach of government into the health system, Democrats unanimously say they've come too far to fail now.
The Senate measure would extend coverage to an estimated 31 million who lack it, while banning the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.
For the first time the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people do so. Employers would be induced to cover their employees through a combination of tax credits and penalties.
Unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion.
In an interview with PBS, Obama signaled he will sign a bill even if it lacks the provision.
"Would I like one of those options to be the public option? Yes. Do I think that it makes sense, as some have argued, that, without the public option, we dump all these other extraordinary reforms and we say to the 30 million people who don't have coverage: 'You know, sorry. We didn't get exactly what we wanted?' I don't think that makes sense," Obama said.
Outnumbered Senate Republicans stubbornly played out a losing hand. They launched several last-minute constitutional challenges that Democrats swatted aside, then rejected calls to move the final vote up a day in deference to a snowstorm that threatened to prevent lawmakers from reaching home on Christmas Eve.
Republicans took to the floor to lambaste the bill as a budget-busting government takeover. Sen. Orrin Hatch, R-Utah, contended that it "just might wind up being the most widely hated legislation of the decade."
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