The House passed its bill in November, and officials said it was likely to be February before the two sides can sort out their differences over issues as diverse as government's role in a remade health care system, coverage for abortion and federal subsidies for lower and middle-income families who would be required to purchase insurance.
Senate Republican attacked the bill to the end, and citing public opinion polls, said they would use it as an issue in the 2010 congressional elections. "This debate was supposed to produce a bill that reformed health care in America. Instead, we're left with party-line votes in the middle of the night, a couple of sweetheart deals to get it over the finish line, and a public that's outraged," said the Republican leader, Sen. Mitch McConnell, R-Ky.
The Senate vote unfolded as the sun rose over the Capitol on the day before Christmas, and marked the culmination of a battle that lasted months and included failed bipartisan negotiations, a last-minute flurryof Democratic dealmaking to lock in 60 votes and a highly partisan debate that held lawmakers in session a near-record 25 consecutive days.
For the third time since Sunday night, Sen. Robert C. Byrd of West Virginia, 92, was wheeled into the Senate so he could cast his vote. Sen. Jim Bunning, R-Ky., did not vote.
For Democrats there was an air of bittersweet celebration, underscored by the presence of Vicki Kennedy in the visitor's gallery that overlooks the Senate floor. Her husband, the late Sen. Edward M. Kennedy of Massachusetts, died in August after a career spent working relentlessly for universal health care.
"With Sen. Ted Kennedy's booming voice in our ears, with his passion in our hearts, we say, as he said: The work goes on, the cause endures," said Reid, echoing words Kennedy uttered in his most famous speech.
Beginning in 2014, the Senate bill would establish insurance exchanges where consumers could shop for private coverage sold under federal guidelines. Most Americans would be required to purchase insurance or face penalties,
and hundreds of billions of dollars in federal subsidies would be available to families up to incomes of about $88,000 a year. Insurance companies would be banned from denying benefits or charging higher fees on the basis of pre-existing medical conditions. That provision would take effect in 2013 in the House version.
The Congressional Budget Office estimates the Senate measure would extend coverage to about 31 million Americans who lack it, while cutting federal deficits by $130 billion over a decade and possibly much more in the following 10 years. Premiums would rise for some, but fall for many others, particularly when the effects of federal subsidies are factored in, the agency says.