WASHINGTON - Senate passage of landmark health-care legislation yesterday took the Democrats' long drive to enact the biggest social-policy change in decades into its final lap - a high-stakes effort to reconcile differences between House and Senate versions of the bill.
With Republicans boycotting, the majority Democrats in the two chambers must grapple with multiple disparities - on abortion, taxes, and the government's role in the health insurance market.
But they are under political pressure to act quickly on President Obama's goal of overhauling a medical system that provides world-class health care for many but is marked by huge gaps in coverage, uneven quality, and skyrocketing costs.
Yesterday's 60-39 vote on strict party lines came in an unusual Christmas Eve session, with exhausted senators gathering at 7 a.m.
It was the 25th day of debate, and Vice President Biden made a rare appearance to oversee the roll call.
Obama hailed the action. "With today's vote, we are now incredibly close to making health insurance reform a reality in this country," he said after the vote. "Our challenge, then, is to finish the job. We can't doom another generation of Americans to soaring costs and eroding coverage and exploding deficits."
One of the most divisive issues among Democrats - a new government-run insurance program known as the public option - is now effectively off the table. And for all the differences between the two bills, they have vast expanses of common ground.
The bill that goes back to both chambers after the House-Senate conference will almost certainly increase by at least 30 million the number of people covered by government or private health insurance.
It will for the first time require most individuals to buy health insurance. But it also will offer federal subsidies to help pay premiums, impose penalties on employers that do not offer workers affordable policies, and set up an insurance exchange where individuals can shop for coverage if they have no job-based coverage.
Insurance companies will have to end practices that have made it hard for people to get coverage when they get sick or have a chronic disease - setting caps on total payments, for example, or denying coverage on the basis of an existing condition.
Health-care professionals will be given incentives to provide more cost-effective care.
"This is a victory because we've affirmed that the ability to live a healthy life in this great country is a right, not a privilege," Senate Majority Leader Harry Reid (D., Nev.) said after the vote.
All that comes with a price tag: The Senate bill would spend $871 billion over 10 years, though it would raise taxes and cut spending in other areas by even more, and so reduce the deficit over time.
Not a single Republican voted for the bill; the only one who did not cast a "no" vote was Sen. Jim Bunning (R., Ky.), who was absent because of family commitments.
GOP leaders did everything they could to delay the vote until Christmas Eve.
They spent more than 80 hours in Senate floor speeches denouncing the Democrats' bill as an expensive, ill-considered, pork-laden "monstrosity."
"This fight isn't over," said Senate Republican Leader Mitch McConnell of Kentucky. "I guarantee you the people who voted for this bill are going to get an earful when they finally get home for the first time since Thanksgiving."
Underscoring the drama of the Christmas Eve roll call, senators voted from their desks on the Senate floor, a custom reserved for the most momentous occasions.
Watching from the public gallery were other soldiers in the long battle for universal health care, including Rep. John Dingell (D., Mich.), dean of the House and lead sponsor of the House bill, and Victoria Kennedy, widow of Sen. Edward M. Kennedy (D., Mass.), a lifelong champion of universal health care who died this year.
"This is for my friend Ted Kennedy," declared the ailing, 92-year-old Sen. Robert C. Byrd (D., W.Va.) before casting his vote.
In a sign of exhaustion after weeks of round-the-clock work on the bill, Reid accidentally voted "no" when his turn came. As his colleagues burst into laughter, he threw up his hands and corrected his mistake.
"I spent a very restless night last night trying to figure out how I could show some bipartisanship," he joked to reporters afterward. "And I think I was able to accomplish that for a few minutes today."
Yesterday's outcome had been almost certain since last weekend, when Senate leaders persuaded the last two holdouts in their caucus - Sens. Joe Lieberman (I., Conn.) and Ben Nelson (D., Neb.) - to support the bill, giving Democrats the 60 votes needed to break the Republican filibuster.
Lieberman joined the effort only after Reid dropped the most controversial part of the plan: an expansion of Medicare. Nelson held out for further restrictions on federal funding for abortion.
Those issues will have to be revisited in House-Senate negotiations to craft a final compromise version of the bill, which will then have to go back to each chamber for approval.
The House and Senate will not formally reconvene until mid-January.
Democrats hope to send a final bill to the White House before Obama delivers his State of the Union address, but they said it would likely take until early February.
The date of Obama's annual speech to a joint session of Congress has not yet been set, but it is expected in late January or early February.
Efforts to reconcile differences between the two versions of the bill are already under way an informal level, and Senate Finance Committee Chairman Max Baucus (D., Mont.) said they would continue next week.
One of the thorniest issues is abortion. The Senate bill's language is not as strict as the House language, which was drafted by Rep. Bart Stupak (D., Mich.), to prohibit anyone receiving federal premium subsidies from buying an individual policy that covers abortion through the new insurance exchange.