The U.S. Senate is on course for a final vote early Thursday on health care reform legislation after a week of wrangling and a series of procedural votes. Democrats have been able to hold together a 60-vote majority required to pass the bill. But, difficult negotiations with the House of Representatives lie ahead, as lawmakers attempt to reconcile differences and send a single bill to President Barack Obama early in the new year.
Though arcane legislative procedures stretched the health care debate through the month of December, senators are now on track to end a process marked by some of the most bitter partisanship seen in the chamber.
The Senate will first vote on Wednesday to formally end debate on a bill that would provide health insurance to about 30 million more Americans, create new private insurance marketplaces, or exchanges, and ban the practice of denying coverage to individuals with existing health problems.
Democratic and Republican leaders reached an agreement to hold a final vote on the legislation at eight o'clock Thursday morning.
Democrats, including Max Baucus of Montana, who steered the legislation through difficult committee-level debates earlier this year, used a news conference to say the Senate is on the cusp of a historic achievement.
"We are truly closer than ever to bringing security and stability to our health care system, to providing real reform that American families, businesses and workers so desperately need," said Max Baucus.
The Senate measure and one already approved by the House of Representatives contain similarities, but also big differences.
Senate Democrats failed to obtain support in their caucus to create a new government-run insurance option, and were forced to drop an alternative plan to make millions of Americans between the ages of 55 and 64 eligible for the government-run Medicare program.
That sets up difficult negotiations with House lawmakers, including the most liberal members, who have insisted that true reform requires a government-run insurance plan, which is included in the House measure.
Asked about the scenario, Senate Majority Leader Harry Reid made clear his main focus is first to get the bill out of the Senate.
"We are focused on passing this bill," said Harry Reid. "We will work with our House counterparts, we will work with the White House, but that is going to come at a subsequent time. Our focus today and tomorrow is to complete this legislation."
Senate and House bills are estimated at $871 billion and $894 billion respectively. However, the 10 year costs of expanding coverage to 94 to 96 percent of Americans is put at more than $1 trillion. Both would provide subsidies for lower-income Americans, paid for through tax increases and reduced spending in the huge Medicare and Medicaid programs.
Republicans, such as Senator Jeff Sessions, continued to hammer away at what they call questionable methods they assert Democrats used to conceal the true budgetary impact of the Senate bill.
"These are huge costs," said Jeff Sessions. "It is not financially-sound. It is not going to reduce our [health insurance] premiums; it is going to increase the percentage of wealth in America going to health care instead of reducing it, like [as] I thought we were supposed to do from the beginning."
In another move to block the bill, Senator John Ensign asserted that a key provision requiring Americans to obtain insurance is unconstitutional.
"Freedom and choice are very precious rights," said John Ensign. "Let's not bury our heads in the sand and take away freedom and choice from American citizens."
President Obama said on Tuesday he would delay his departure for a vacation in Hawaii to await the outcome of the Senate vote.
"I will not leave until my friends in the Senate have completed their work," said Mr. Obama. "My attitude is that, if they're making these sacrifices to provide health care to all Americans, then the least I can do is to be around and provide them any encouragement and last minute help where necessary."
Recent public opinion polls have shown declining support among Americans for the Senate's health care reform bill, and the president has also seen his personal job approval ratings decline.