Vicki Kennedy, widow of the late Sen. Ted Kennedy, greets Senate Majority Leader Harry Reid following a 60-40 cloture vote which is the first step in passing the health care bill. Senate advances landmark health bill

The Democratic Party’s decades-long push to remake the U.S. health care system cleared a major hurdle early Monday morning, with the Senate voting to advance a massive $871 billion bill to extend coverage to nearly all Americans and tighten regulations on private insurers.

Less than two days after releasing a bill with 383 pages of changes, Senate Majority Leader Harry Reid (D-Nev.) corralled his politically diverse caucus and delivered the 60 votes necessary for the most crucial test vote in the legislative process so far — effectively ensuring the reform package will clear the Senate later this week.


The final tally was a straight party-line vote, 60-40. All Democrats and two independents voted yes and all Republicans voted no — and each side bitterly accused the other of trying to thwart true reform through petty gamesmanship.

The senators voted just after 1 a.m. while seated at their desks, a rarely used practice implemented only for historic votes.

Adding to the sense of history: The late Sen. Ted Kennedy’s widow, Victoria Kennedy, watched the vote from the Senate gallery, then accepted hugs from a parade of Democratic senators who had just cast votes to move the nation toward Kennedy’s dream of universal health care.

"I feel fantastic," Kennedy told a small group of reporters. "This is an enormous victory."

Alongside Kennedy, White House health reform czar Nancy-Ann DeParle and Health and Human Services Secretary Kathleen Sebelius also watched the Senate vote, a victory for President Barack Obama on his top legislative priority. "We're excited and moving on to the next vote," DeParle told POLITICO.

If the Senate passes the bill as expected — after two more procedural votes this week and a final vote set for 7 p.m. Christmas Eve — House and Senate negotiators will begin the arduous process of melding two substantially different bills. Democrats are optimistic they can reach a final compromise, but that is by no means ensured.

And within minutes of the vote, two of the final holdouts, Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.) were already threatening to withhold their votes if the bill drifts closer to the House bill, which includes a public health insurance option and different ways to pay for reform.

“Conferences with the House often split the difference. This is a very fragile balance that brought 60 together. So I think it's critically important if we're going to adopt health care reform legislation that the bill that comes back from conference is essentially what passed the Senate,” Lieberman said. “I know that's asking a lot of our colleagues in the House, but that's the practicality of where we are.”

Those are fighting words to House members — who bristle at being dictated to by the upper chamber — but some House Democrats have acknowledged they may have little choice but to stick with the bulk of the Senate bill, if they hope to preserve health reform.

Monday’s vote to continue with debate presented the clearest threat yet to the bill. Most senators viewed the vote — even though it was a procedural motion — as a vote on the bill itself. This left Reid with no margin for error, forcing him to strike a compromise that would appeal to a self-described socialist from Vermont (Sen. Bernie Sanders), an increasingly conservative independent from Connecticut (Lieberman) and every Democrat in between.

Until Reid secured Nelson’s support late Friday night, the bill was in doubt.

But after nearly a year of discussion and debate on health reform, there was little suspense about the final outcome of the early-morning vote. One by one, wavering Democrats announced their intentions to vote yes — just as every single Republican announced plans to vote no.

Just moments before the vote, Reid said, “We have before us the ability to provide quality health care to every American, and we have the ability to treat our unhealthy health care system. That’s what this historic bill does.”

But Democrats also made clear that they felt Republicans weren’t playing fair by taking up every hour of debate available to them — which would lead to the vote on the night before Christmas.

"It's up to [Senate Republican leader] Mitch McConnell if we stay here through Christmas. If he thinks it's good theater, I guess we'll stay,” said Sen. Chuck Schumer (D-N.Y.). “But the die is cast. This bill is now going to pass the Senate."

Republicans shot back that it was the Democrats who were ramming through a massive piece of legislation on a hurried wee-hours roll call. McConnell (R-Ky.) said it amounted to "a couple of cheap deals and a rushed vote at 1 o'clock in the morning. And Americans are wondering tonight, how did this happen?"

“It is one of the most consequential votes any of us will take, but make no mistake, if the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” he said.

As of Monday morning, Republicans still sounded ready to dig in, with Sen. John McCain saying they’d fight until the final vote.

The only Republican who even considered backing the plan, Sen. Olympia Snowe (R-Maine), was still being courted by the White House even at midnight, with legislative liaison Phil Schiliro approaching Snowe as she got off an elevator in the Capitol. Snowe met Obama again Saturday, a continuation of the intense personal appeal by the president.

Snowe voted no Monday morning, but left open her final vote. “It depends on what it is and the direction it moves in. I will continue to work with them," she told reporters.

The bill would extend coverage to 31 million uninsured Americans by expanding Medicaid, creating new insurance subsidies, setting up a national insurance marketplace and offering private plans nationwide administered by the same federal agency that oversees federal employee benefits. No longer could firms deny insurance over pre-existing conditions or set a lifetime limit on benefits.

But the plan falls far short of Obama’s initial vision for reform in one key regard — Democrats stripped out a government-run insurance option after several moderate Democrats said they’d block the bill if it remained.

That decision has drawn sharp fire from the party’s liberals, who have said the Senate plan isn’t true reform and would merely enrich private insurers — setting up a showdown with moderates, who have threatened to walk if liberals try to force it back in.

Obama has had increasing trouble from his left flank, which has questioned why he didn’t fight harder for some of their core principles, like a government-run plan. One of the leading critics of the Democrats’ approach, former Democratic National Committee Chairman Howard Dean, on Sunday toned down his criticism of the Senate bill but made clear he didn’t consider this the final word.

“This can’t be the final version of the bill,” Dean said on NBC’s “Meet the Press.” “It simply sets us on a track in this country which is expensive and where we’re going to have lots more political fights.”

Abortion also roiled the health debate in its closing hours ahead of the Senate vote, as Nelson fought for new restrictions on federal funding of abortion that angered both sides — abortion opponents and those those who favor abortion rights.

Sen. Barbara Boxer (D-Calif.) helped broker the compromise with Nelson and told reporters that she had discussed the language afterward with House Speaker Nancy Pelosi, who the senator described as supportive.

The partisan tensions, which have grown increasingly toxic, came into sharp relief on the Senate floor ahead of the vote.

McConnell described the bill as a “mess” that Americans overwhelmingly opposed. Highlighting the power of a single senator, McConnell pleaded for one member of the Democratic Caucus to break ranks.

“Americans are asking Democrats to put party loyalty aside tonight — to put the interests of small-business owners, taxpayers and seniors first,” he continued. “And here’s the good news — it’s not too late. All it takes is one. One can stop it — or everyone will own it.”

None answered his call.

Reid was able to hold his caucus together, in part, by writing state-specific provisions that won over senators, one vote at a time.

Nebraska, Vermont and Massachusetts scored $1.2 billion in special Medicaid assistance. Nelson got something for Nebraska the other states didn’t — a permanent exemption from increased state costs for new patients that come into Medicaid through the plan.

Montana, North Dakota, South Dakota, Utah and Wyoming secured higher federal reimbursement rates for doctors and hospitals that serve Medicare patients.

Senior citizens in Florida, Pennsylvania and New York will see their Medicare Advantage benefits protected at a time when the program will be trimmed nationwide.

Jim Manley, Reid’s spokesman, defended the special provisions as “a normal part of the legislative process.”

But Republicans, despite their use of similar tools while in the majority, spent Sunday blasting Democrats.

"This process is not legislation. This process is corruption,” Sen. Tom Coburn (R-Okla.) said. “And it's corruption that's obvious to the average American in this country," Coburn said. "And it's a shame that that's the only way we can come to consensus in this country is to buy votes."

Coburn also blasted a mystery provision tucked into the bill, $100 million for a university hospital. Reid’s office could not say what senator asked for it, but late Sunday night, Sen. Chris Dodd fessed up, saying he’s hoping the money will come to the University of Connecticut. Dodd is facing a difficult reelection battle.

Coburn also said he hoped one of his fellow senators didn’t show up for the pivotal 1 a.m. vote — an admission that Republicans were powerless to stop the procession of votes toward passage.

“What the American people ought to pray [for] is that somebody can’t make the vote tonight. That’s what they ought to pray,” he said.

Democrats interpreted the comments as a veiled wish that one of them would suffer some misfortune. Majority Whip Dick Durbin (D-Ill.) challenged Coburn three times to come to the floor to explain what he meant. Durbin said he tried to contact Coburn through his office and the Senate GOP cloakroom but got no response.

“I don’t think it’s appropriate to be invoking prayer to wish misfortune on a colleague. And I want him to clarify that,” Durbin said. “He is my friend and I have worked with him. But this statement goes too far.”