Even if successful, drafting a compromise measure with the House of Representatives may be the toughest part of all
This is President Barack Obama's biggest legislative priority. And it could have an impact on the health and wealth of Americans for generations to come.
The drafting process has proven cumbersome and controversial. In the Senate, extraordinary steps were taken to win the support of a handful of Democrats who threatened to vote "no."
With the last hold-out, Senator Ben Nelson of Nebraska, now on board, the focus on Capitol Hill is beginning to shift to the crucial task of reconciling the more liberal House version, with the one expected to clear the Senate before Christmas.
A top advisor to the president indicates there is no doubt at the White House a piece of legislation will eventually clear Congress. David Axelrod told the NBC television program Meet the Press that the Senate has moved the process forward.
"Obviously, it is a big step along the way," he noted. "We have got additional steps to take. The House has a bill. The Senate has a bill."
Axelrod said work on a House-Senate compromise will begin in January, when Congress returns from its holiday recess. He predicted it will be tough, but doable.
"Seven presidents have tried to pass comprehensive health insurance reform. Seven presidents have failed. We have been talking about it for a hundred years. We are on the doorstep of getting it done and it will be a great victory for the American people," he added.
Both the House and Senate bills attempt to improve the accessibility and affordability of health care in a nation where most people rely on private insurance to meet medical costs.
But there are major differences in approach. The House includes a government-funded health care plan to help the 30 million Americans without private insurance. The Senate bill does not provide for a so-called "public option," but does add more restrictions on government funding for abortions.
North Dakota Senator Kent Conrad, the chairman of the Senate Budget Committee, will play a major role in negotiations on the final language of the bill. He told the Fox News Sunday television program, the Senate version must prevail because it will take take far more than a simple majority to clear all the possible procedural hurdles to final passage.
"I think any bill has got to have to be very close to what the Senate has passed because we are still going to have to get 60 votes," he said. "And anybody who has watched this process can see how challenging it has been to get 60 votes."
That means holding on to all 58 Democrats in the Senate plus the two independents who caucus with the party. Republicans have all voiced opposition to the bill.
Senator John McCain of Arizona told Fox News Sunday the Republicans will not back down.
"We will fight until the last vote," he said. "We owe that to our constituents because we can't - we must [be able to] look back and say we did everything we can to prevent this terrible mistake from taking place."
McCain said the health care reform legislation making its way through Congress will have a devastating impact on the national debt. But Conrad said congressional accountants have said it will actually cut the debt in the long term.