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Senate Democrats vote to bring health bill to floor for debate

But Democratic leaders said the vote provided a jolt of momentum that vastly improved prospects for a completed Senate bill before the Christmas break, leaving January for negotiations with the House. The goal now is to deliver final legislation to Obama in time for the State of the Union address in late January.

Reid requested that senators vote from their chairs, a formality generally reserved for such historic matters as the confirmations of Supreme Court nominees. Sen. George V. Voinovich (R-Ohio) was not present and did not vote.

Afterward, supporters of health-care reform gathered outside the Capitol to cheer Democratic lawmakers as they left the building. And a tearful Vicki Kennedy, widow of Sen. Edward M. Kennedy (D-Mass.), called Reid to applaud his efforts on her late husband's behalf.

"We know not all 60 senators in my caucus agree on every aspect of this bill," Reid told reporters. "But they agree on the vast, vast majority."

The Senate bill would provide coverage to 31 million uninsured Americans by vastly expanding Medicaid and creating insurance "exchanges" for individuals who do not have access to affordable coverage through their employers. For the first time, it would require most people to carry health coverage, although families with incomes up to 400 percent of the federal poverty level would receive subsidies to buy policies.

The legislation would also force widespread changes to the insurance industry to end discriminatory practices, including the rejection of coverage based on preexisting conditions. It would provide new incentives to encourage disease prevention and to institute the most effective treatments for chronic conditions such as diabetes and asthma.

On the revenue side, the Senate bill would extract about $400 billion in cost savings from Medicare and Medicaid, and would impose an excise tax on the most generous health-care policies, dubbed "Cadillac" plans. It would raise payroll taxes for high earners and levy a 5 percent tax on elective cosmetic surgery.

Even before he released the bill last week, Reid started work on securing the votes for Senate passage. He canvassed Democrats in private meetings and phone calls, and urged groups of senators with shared interests to work together on amendments. Leadership aides also drew up lists of potential Republican amendments to devise how Democrats would respond.

Along with the three Democratic moderates who have stepped forward, two other senators are likely to become frequent visitors to Reid's office in the weeks ahead. Like Nelson, Landrieu and Lincoln, independent Sen. Joseph I. Lieberman (Conn.) opposes the public option but agreed to support the start of debate. Unlike the moderate Democrats, Lieberman has stated unequivocally that he would oppose a government insurance plan in any form.

That leaves Reid with two options. Either he must persuade liberal lawmakers to give up the provision, or he must win back Olympia J. Snowe (Maine), the only Republican to support the Senate Finance Committee bill.

Nelson, Landrieu and other moderate Democrats have suggested they can support an alternative version of the public option proposed by Snowe; it would take effect only if private policies prove unaffordable. Democrats are hopeful they can win her back as the debate advances and said she has continued to negotiate with Reid. But Snowe said, "The conversations have to translate into something specific . . . and that hasn't happened."

Staff writer Lori Montgomery contributed to this report.

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