Democrats took their most important step yet toward passing a law to remake the nation's health system with a procedural vote in the wee hours Monday morning that clears the way for passage this week.
A record-setting blizzard in Washington and vehement Republican opposition didn't stop the Democrats and two independent senators from overcoming a threatened GOP filibuster in a 60-to-40 party-line vote.
Two more procedural votes lie ahead, but by forging a filibuster-proof 60-vote bloc, the Democrats are poised to pass a health bill in the Senate by Christmas.
The Senate bill would bring health coverage to about 30 million uninsured people in the U.S. within a decade and curtail insurance industry practices that make it difficult for people to get and keep private coverage. The Congressional Budget Office estimates it would cost $871 billion over the first 10 years.
The key development over the weekend was the agreement by Sen. Ben Nelson, a Democrat from Nebraska, to back the bill in return for restrictions on abortion funding and a provision that would send $45 million in federal Medicaid money to Nebraska to cover an expansion of the program.
"Change is never easy," Nelson said in a statement Saturday. "But change is what is needed in America today." He said he would vote for the overhaul "because it will deliver relief from rising health care costs" to Nebraskans.
Republicans vowed to fight on. "There is nothing inevitable about this," Sen. John Cornyn (R, TX), said after the vote. "The only thing I think inevitable about it is in the light of the unpopularity of what is being jammed down the throats of the American people, there will be a day of accounting," the New York Times reported.
If the Senate passes the bill as expected, it would then have to be reconciled with House bill, a process that would stretch into next month. Plenty of details would have to be hammered out.
To win support for the bill, Senate Majority Leader Harry Reid dropped a government-run insurance option and later a proposal to let people buy Medicare coverage starting at age 55. The House bill still includes a public option for coverage that people without insurance could buy through exchanges that would be created by the new law.
Under both bills people would be required to have health insurance, with a few exceptions. Those who don't get coverage through employers or existing government plans, such as Medicaid, would then buy insurance through newly established marketplaces, or exchanges.