WASHINGTON, Nov. 21, 2009 -- Senate Democrats united today to overcome a Republican filibuster and officially move a health-care overhaul bill to the Senate floor, clearing the way for weeks more debate on their largest major domestic policy initiative and the most ambitious attempt at health care reform in generations.
In a rare weekend vote, with Senators sitting in their assigned seats to signify the importance of the moment, Democrats secured help from nervous moderate members and reached the 60 votes they needed to hold off a procedural roadblock set up by Republicans.
All 58 Democrats and two independents voted to break the filibuster on the bill, which Senate Majority Leader Harry Reid released Wednesday night. The Nevada Democrat took parts of proposals passed earlier this year through two congressional committees to build the sweeping $848 billion proposal.
The Republicans mustered 39 votes. Sen. George Voinovich, R-Ohio, did not vote.
Earlier in the day, it appeared that the bill would get the votes it needed when Sen. Blanche Lincoln, D-Ark, who had been the final Democratic holdout, said she would vote with the rest of her party.
"I have concluded that I believe it is more important that we begin this debate to improve our nation's health care system for all Americans rather than just simply drop the issue and walk away. That is not what people sent us here to do," Lincoln said.
But her speech on the Senate floor, while it assured a small victory for Democrats, also highlighted the real divides among Democrats that threaten their efforts to overhaul health care in the future.
"Let me be perfectly clear, I am opposed to a new government-run insurance option," she said.
Lincoln, who faces a tough reelection campaign in 2010, criticized both Republicans and liberal political groups for trying to influence her position.
"I will not allow my decision on this vote to be dictated by pressure from my political opponents, nor the liberal interest groups from outside Arkansas that threaten me with their money and their political opposition," she said.
Landrieu Defends Money for State
Sen. Mary Landrieu of Louisiana also announced her support for the procedural motion today and she defended her role in securing a provision in the bill that provides states that have suffered extreme natural disasters extra help in paying for its share of Medicaid services.
Her state, after Hurricane Katrina, is the only one that would currently qualify for the extra help.
But Landrieu, far from distancing herself from it, said it is her job as a Louisiana senator to secure federal money for Louisiana. Further, she said the provision will benefit Louisiana with $300 million, not the $100 million estimated by CBO.
Health Care Overhaul Bill Raises Moderates' Concerns
"I am not going to be defensive about asking for help in this situation. And it's not a $100 million fix, it's a $300 million fix," she said.
She clarified that her vote was not an endorsement of Reid's bill and said she might ultimately vote against the legislation if it is not changed during the Senate floor debate.
Landrieu said wants to see the bill changed to give more help to small business owners, arguing that many of the reforms in the bill would not take place until 2014 and, most importantly, that she opposes the framework of the public health insurance option in Reid's bill.
While Reid's proposal is for states to individually ban the public option for their residents, Landrieu prefers a proposal by Sen. Olympia Snowe, R-Maine, that would only create a public insurance option in places where the private market fails to provide affordable options.
Sen. Ben Nelson, D-Neb, announced Friday that he supported opening debate on the legislation. Like Landrieu, Nelson argued that his vote in favor of breaking the filibuster does not guarantee support for the final measure.
"In my first reading, I support parts of the bill and oppose others I will work to fix. If that's not possible, I will oppose the second cloture motion -- needing 60 votes -- to end debate, and oppose the final bill," Nelson said. "But I won't slam the doors of the Senate in the face of Nebraskans now. They want the health care system fixed. The Senate owes them a full and open debate to try to do so."
Republicans had targeted Nelson to vote against the bill, not only because of the public option and its cost, but also because he generally supports limiting abortion rights, and Reid's bill has a less strict prohibition on federal funds being used for abortion than does the version that passed the House.
Unlike the House debate on a Saturday several weeks ago, the debate today struck a much more sedate tone.
Senators signed up in advance for time periods, with Republicans and Democrats alternating hours. Few other senators were on the floor besides those speaking or waiting to speak. The spectator's gallery was about half full in mid-afternoon, and there were no signs of demonstrators outside the Capitol.
GOP: 'We're Going to Do Everything We Can to Bring a Stop to This'
Republicans seem destined to lose their bid to kill the Democrats' health-care overhaul efforts by filibustering Reid's bill off the Senate floor.
But Sen. Mitch McConnell of Kentucky, the minority leader, pledged to carry the fight into the future.
"The American people are asking us to stop this bill and we're going to do everything we can to bring a stop to this before it becomes law," he said at a press conference on Capitol Hill amid today's unusual session.
"The time of maximum opportunity to affect this bill is now," McConnell said, trying to convince moderate Democrats to support the Republican filibuster.
Sen. Richard Burr, R-N.C., was in the holiday spirit and had some good zingers.
"This is the Harry Reid layaway plan for the holiday season," Burr said. "Pay in for four years before you get anything out of it."
Burr was referring to the structure of Reid's bill, in which the main reform components, such as creation of state-based insurance exchanges and the public option, are not up and running until 2014.
So while the bill is officially scored by the CBO as costing $848 billion, Republicans argue that for the 10 years after the changes take effect, from 2014 to 2024, the cost is over $2 trillion.
Republicans have taken every opportunity to slam the Democrats' bill for being too long at more than 2,000 pages. They have printed a number of copies of the bill on single-sided pages, and stand before large stacks of paper to make their speeches.
Burr hoisted the bill as he spoke at the Republicans press conference.
"This 20 pounds is the size of most people's turkey next week and that's what most people in North Carolina think of it," he said.
New Insurance Rules Mark Senate Proposal
Reid's proposal is similar in many ways to a bill that passed the House of Representatives this month, but it is different in the way it pays for coverage, and it creates a public option.
Both bills seek to remake the way health care is delivered in the United States by instituting new rules for insurance providers, setting up new exchanges to make it easier and more transparent for people without employer insurance to get insurance coverage.
Reid's bill would give states the option of not using the public option. The bill is paid for with new taxes on couples who make more than $250,000 per year and on people, rich or not, who have generous, all-inclusive benefit plans that are valued at more than $8,500 each year.
Sen. Dick Durbin, D-Ill., who is the chief vote counter for Democrats, pledged again Friday to pass a bill through the Senate this year, even if it "could jeopardize Christmas."
But despite the Democratic victory in the procedural vote today, the future of the bill remains murky.
Moderate Democrats have real issues with the bill and leaders have tried to draw a distinction between voting to debate the bill and voting to pass the bill after a floor debate later on.
AARP CEO Addison Barry Rand drew the same distinction in a letter written Friday encouraging Senators to vote to debate the bill without exactly endorsing the full bill.
Moderates like Nelson, Landrieu and Lincoln have not seemed likely to bend in their opposition to the public option. Sen. Joe Lieberman, an independent whose vote Democrats will need, has opposed the public option in Reid's bill.
Liberals like Sen. Roland Burris of Illinois said they won't vote for a bill that doesn't include a public option.
Someone will either have to break their pledge or change their mind for Democrats to pass a bill.
Health Care Bill: Senate Confrontation
Republicans remain united against Reid's proposal. Democrats could woo support from one Republican -- Maine's Olympia Snowe -- if they made creation of the public option dependent on a trigger, such as affordability benchmarks that private insurers would be given the opportunity to meet. But liberals in the party would revolt.
For now, all Republicans are poised to oppose Reid's bill, which they argue would represent a government takeover of health care. It also relies on nearly half a trillion dollars in cuts to future Medicare spending. Republicans argued the bill should not cut the current government-run programs for seniors.
But the debate turned away from the public option and Medicare Friday, toward the heated national debate on cancer screening and task force recommendations to relax recommendations for both breast and cervical cancer.
Republicans argued those recommendations should be a warning of what would happen under the Democrats' bill.
"At what point is the government going to step in and say, 'We are not paying for that and you are going to die earlier than you would if you had received that treatment,'" said Sen. John Cornyn, R-Texas.
"This is how rationing starts. And that's the point.," said Jon Kyl, R-Ariz.
But Democrats pointed out that while the task force is mentioned in their bill, it is only to make recommendations to the secretary of Health and Human Services, who would be the final arbiter of what screening services would be offered to people with insurance. They said 31 million more people would have insurance -- and access to screening -- under their bill.
"The panels are free to make whatever recommendations they like. But it is up to the Congress to set public policy," said Sen. Arlen Specter, D-Pa., himself a cancer survivor.
ABC News' Vic Ratner contributed to this report.