WASHINGTON — The Senate approved a landmark health care bill Thursday morning that would provide coverage to more than 30 million people and begin a far-reaching overhaul of Medicare and the private insurance market.
Vice President Joe Biden presided over the 60-39, party-line vote, which brings Democrats closer than ever to realizing their 70-year-old goal of universal health coverage.
For the first time, most Americans would be required to obtain health insurance, either through their employer or via new, government-regulated exchanges. Those who can't afford insurance plans would receive federal subsidies. And Medicaid would be vastly expanded to reach millions of low-income children and adults.
"We stand here at the finish line ... with millions of American families who have been forced into bankruptcy over the cost of health care ... on behalf of 45,000 Americans who die each year simply because they don't have health insurance," Sen. Max Baucus, D-Mont., told reporters after the vote. "Today, we make history for them and every American who has fallen victim to our broken health-care system."
Difficult issues must be still resolved in final negotiations with the House, which has passed more liberal health care reform legislation. Those talks could stretch through January and perhaps into February, Democratic leaders said.
But Democrats are increasingly confident that President Barack Obama will sign a bill into law in early 2010 that would prevent insurers from refusing coverage to people with pre-existing conditions, limit the amount individuals have to pay for their own care and require other reforms that Obama called "the toughest measures ever taken to hold the insurance industry accountable."
"We are now incredibly close to making health insurance reform a reality in this country," Obama told reporters in a White House appearance shortly after the Senate vote. "Our challenge now is to finish the job."
On the Democratic side of the chamber, lawmakers were exuberant as the votes were cast between 7 and 7:16 a.m. Thursday. Laughter erupted when Senate Majority Leader Harry Reid, Nev., mistakenly started to vote no on the bill, then quickly switched to aye. "I spent a very restless night last night trying to figure out how I could show some bipartisanship," Reid joked later, appearing before reporters with several other Democratic leaders. "And I think I was able to accomplish that for a few minutes today."
Sen. Robert C. Byrd, D-W.Va., who is 92 and ailing, bellowed when his name was called: "Mr. President, this is for my friend Ted Kennedy. Aye."
Byrd, who arrived in a wheelchair for multiple late-night and pre-dawn votes over the last week, was paying tribute to the late Massachusetts senator, who championed health care reform until he died of brain cancer this year.
Kennedy's widow, Victoria Reggie Kennedy, came to the Capitol to witness the unusual Dec. 24 vote.
Also seated in the visitors gallery was Rep. John Dingell, D-Mich., the longest serving member of the House and a champion of health care reform. After the vote, Dingell said of the Senate victory, "This is the end of a long, hard and necessary journey."
But Senate Minority Leader Mitch McConnell, R-Ky., vowed to wage an even tougher battle when Congress returns in January and Democrats attempt to merge the House and Senate bills. "This fight is not over. This fight is long from over," McConnell said. "My colleagues and I will work to stop this bill from becoming law."
Reid said the bill's passage was a victory because "we've affirmed that the ability to live a healthy life in our great country is a right and not merely a privilege for the select few."
He declined to speculate about the upcoming negotiations with the House, after telling reporters Wednesday that he wanted a few days of peace back home in Nevada over the Christmas holiday. "I am going to just sit back and watch my rabbits eat my cactus," he said.
Republicans fought the Senate health bill with every parliamentary weapon they could muster, raising a series of motions in recent days that failed along party lines.
The last preliminary vote came Wednesday, when all 60 members of the Senate Democratic caucus voted down the final possibility for a Republican filibuster of the $871 billion package. All but one of the 40 Republican senators was present for the vote; all 39 of them voted against the bill. The absent senator was Jim Bunning of Kentucky, who is retiring in 2010. He also was not present for Thursday morning's votes.