On to the Senate floor....

Washington (CNN) -- Health care reform backers won a key victory Saturday night as the Senate voted to move ahead with a floor debate on a sweeping $848 billion bill.

The 60-39 vote to prevent a Republican filibuster against the start of debate on Senate Majority Leader Harry Reid's legislation broke down along strict party lines. All 58 Senate Democrats -- along with independent Sens. Joe Lieberman of Connecticut and Bernie Sanders of Vermont -- supported bringing the measure to the floor.

Thirty-nine of the 40 Senate Republicans opposed the motion. Sen. George Voinovich, R-Ohio, didn't vote.

"Tonight's historic vote brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance and extending quality health coverage to those who lack it," White House Press Secretary Robert Gibbs said in a statement.

The polarized vote set the table for a holiday season now virtually certain to be marked by acrimonious deliberations on President Obama's top domestic priority.

Top Senate Democrats, who are trying to pass a bill before the end of the year, spent much of the day tarring their Republican colleagues as defenders of a broken status quo benefitting rich insurance companies at the expense of ordinary American families.

Republicans, in turn, slammed Democrats for pushing a bill that conservatives insist will force millions of Americans to drop insurance plans they like while boosting premiums, raising taxes and leading to government rationing of care.

Read the health care bill (PDF)

"Today we [decide] whether to even discuss one of the greatest issues of our generation," Reid, a Nevada Democrat, said shortly before the vote. "Whether this nation will finally guarantee its people the right to live free from fear of illness and death, which can be prevented by decent health care for all."

The Republicans "are frightening people," said Sen. Tom Harkin, D-Iowa. "Now is not the time to go wobbly in the knees. Now is the time to stand strong ... and move this country forward."

"This bill... is a massive monument to bureaucracy and spending," replied Senate Minority Leader Mitch McConnell, R-Kentucky. It "imposes punishing taxes on almost everyone. ... A vote in favor of proceeding to this bill is a vote in favor of adding to the tax burden of the American people in the midst of double digit unemployment."

The bill "does worse than nothing," said Sen. Chuck Grassley, R-Iowa. It "threatens the economic recovery. ... Changes to the health care system must be responsible and not break the backs of the taxpayers."

The procedural vote represented another milestone in what has become an epic battle over the future of America's health care system.

The House of Representatives narrowly passed a more than $1 trillion bill this month. If the Senate also manages to pass a bill, a congressional conference committee will then need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to Obama's desk to be signed into law.

The nonpartisan Congressional Budget Office has projected that Reid's 2,074-page bill would extend health insurance coverage to 31 million additional Americans.

The agency estimates that the proposal would reduce the federal deficit by $130 billion over the next 10 years, through 2019. Any effect on the deficit in the following decade would be "subject to substantial uncertainty," but probably would result in "small reductions in federal budget deficits," according to budget office analysts.

A minimum of 60 votes is required to break a filibuster in the 100-member Senate. The outcome of the Senate vote was unclear before Saturday afternoon, when Sen. Blanche Lincoln, D-Arkansas, announced her intention to back a floor debate on the measure.

Lincoln, a key moderate probably facing a tough re-election campaign in 2010, said the issue deserved further debate and consideration. She made clear, however, that she opposes several aspects of Reid's bill, including a controversial government-run public option.

"Although I don't agree with everything in this bill, I believe it is important to begin debate," Lincoln said.

"The issue is very complex. There is no easy fix."

Republicans wasted no time tearing into Lincoln's vote, issuing a news release while she was still announcing her decision, proclaiming that she had caved to "pressure from the left wing of her party."

"There's no doubt that this vote will be a critical issue for Sen. Lincoln as she embarks on her uphill re-election bid," said Amber Wilkerson Marchand, a GOP spokeswoman. "The people of Arkansas will have an opportunity to hold her accountable when they cast their ballots next November."

Two other Democratic moderates whose support was considered to be in doubt -- Nebraska's Ben Nelson and Louisiana's Mary Landrieu -- also announced their decision to back a full debate shortly before the vote.

Reid's bill, projected to ensure coverage for 94 percent of Americans, includes a range of tax increases and new fees.

The Medicare payroll tax on individuals earning $200,000 a year and couples earning $250,000 a year would increase by half a percentage point, from the current 1.45 percent to 1.95 percent. In addition, insurers providing costly health coverage -- known as Cadillac plans -- would face a 40 percent tax on policies worth more than $8,500 for individuals and $23,000 for families.
SENATE'S HEALTH BILL
Key components of the Senate's health care bill:

? Includes a government-run public health insurance option.

? Prohibits illegal immigrants from participating in a health insurance exchange created for those unable to afford health coverage.

? Prohibits the use of federal funds for abortion coverage in the exchange.

? Increases Medicare payroll tax on individuals earning $200,000 a year and couples earning $250,000 a year.

? Requires individuals to buy health insurance, with a fine for noncompliance.

? Does not mandate that all employers offer health care.

? Prevents insurance companies from denying coverage for pre-existing conditions.
RELATED TOPICS

* Health Care Policy
* U.S. Senate
* Blanche Lincoln
* Mary Landrieu
* Harry Reid

The bill also includes a 5 percent tax on the cost of elective cosmetic surgery, as well as new fees for insurers and pharmaceutical manufacturers. The total projected revenue raised by all the taxes and fees would exceed $200 billion.

The bill would require individuals to buy health insurance, with a fine for non-compliance of $95 in the first year that would escalate to $750 by 2016.

Unlike the plan recently passed by the House, the Senate bill does not mandate that all employers offer health care. Businesses with more than 50 workers, where at least one employee qualifies for government subsidies, would face a penalty of $750 for every full-time employee if it does not offer health care coverage.

Reid's bill also would expand government-run Medicaid coverage for the poor to everyone making less than 133 percent of the national poverty level.

Democratic leaders in both chambers have been wrestling with the most contentious issues, including abortion and immigration, as well as how to pay for reform.

The House bill has more restrictive abortion language and includes a 5.4 percent income tax surcharge on individuals making more than $500,000 and couples earning more than $1 million.

Both bills include a government-run public option, but the Senate version allows states to opt out before the national program would go into effect in 2014.

The two bills are virtually identical on a broad range of changes, including creating health insurance exchanges, expanding Medicaid, subsidizing insurance for low- and some middle-income families, and capping out-of-pocket medical expenses while preventing insurance companies from denying coverage for pre-existing conditions.

Insurers under both plans would be barred from charging higher premiums based on a person's gender or medical history.


Health care debate headed to Senate floor - CNN.com

WASHINGTON - A bipartisan amendment to increase insurance benefits for women through yearly screenings is expected to get the first Senate vote Tuesday on health care overhaul legislation.

The amendment ? co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine ? would require policies to include a variety of yearly screenings and was inspired in part by controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cancer.

"My amendment guarantees screening for breast cancer, yes, mammograms," Mikulski said. "We don't mandate that you have a mammogram at age 40. What we say is discuss this with your doctor, but if your doctor says you need one, my amendment says you are going to get one." A vote was expected Tuesday afternoon.
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The Congressional Budget office said the amendment would cost $940 million over a decade.

Mikulski has said that her amendment was aimed at preventing insurance companies from using a pair of recommendations for cancer testing in women to deny coverage. Republicans, too, insisted that the recommendations could result in rationing of health care, a charge President Barack Obama's White House has heatedly denied.

Last month, a government-appointed but independent panel of doctors and scientists said women generally should begin routine mammograms in their 50s, rather than their 40s. Then, in an apparent coincidence, the American College of Obstetricians and Gynecologists said that most women in their 20s can have a Pap test every two years ? instead of annually ? to catch slow-growing cervical cancer.

Neither the task force, which provides advice to government officials who may or may not act on it, nor the ACOG set federal policy.

But the recommendations could not have come at a worse time for majority Democrats, especially Senate leaders trying to hold together the 60 votes required to advance the health care overhaul.

The legislative struggle is expected to last for weeks in a test that pits GOP senators determined not to give ground against Senate Democrats determined to deliver on Obama's signature issue.

The 10-year, nearly $1 trillion legislation includes a first-time requirement for most Americans to carry insurance, greatly expands the Medicaid federal-state insurance program for the poor, and would require insurers to cover any paying customer regardless of their medical history or condition.

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On Monday each side offered the first of what are likely to be dozens of amendments, with the measures seemingly designed as much to court a skeptical public as to reshape Senate Majority Leader Harry Reid's 2,074-page bill.

Sen. John McCain, R-Ariz., attacked the legislation as a "monstrosity" that employs "Bernie Madoff accounting, Enron accounting" as he offered the first GOP amendment. McCain's amendment would strip out more than $400 billion in Medicare cuts to home health providers, hospitals, hospices and others ? a pitch to seniors, who polls show have deep concerns about the legislation.

Democrats planned to go on the offense on the same issue Tuesday with an amendment underscoring benefits to seniors and guaranteeing that basic Medicare benefits would not be touched.


Video
Diagnosing the Senate bill
Dec. 1: Sen. Ron Wyden, D-Ore., discusses how premiums won?t increase under the Democrats? plan to reform health care.

Morning Meeting
The Congressional Budget Office has estimated that 31 million uninsured individuals would receive insurance if the bill were enacted, many of them assisted by federal subsidies. The legislation would be paid for through a combination of cuts in projected Medicare payments, a payroll tax on the wealthy and taxes on drug makers, medical device manufacturers, owners of high-cost insurance and others.

It has taken months to advance the legislation to the floor, as Democrats struggled with their own internal divisions as well as Republican opposition.

Democrats control 60 seats in the Senate, precisely the number needed to trump a promised Republican filibuster, and Reid's ability to steer the bill to passage will depend on finding ways to finesse controversial provisions within the measure, such as a proposal for the government to sell insurance in competition with private firms.

Despite the public jousting, significant action was occurring behind the scenes as Reid, D-Nev., and Finance Committee Chairman Max Baucus, the bill's author, huddled Monday with top White House and Cabinet officials. The group included Chief of Staff Rahm Emanuel, Interior Secretary Ken Salazar and Health and Human Services Secretary Kathleen Sebelius, along with former Senate Democratic Leader Tom Daschle, Obama's first pick for HHS secretary before his nomination was derailed.

Liberals favor the government insurance plan; moderate and conservative Democrats oppose it. As drafted, the bill establishes a so-called government option, although each state can block it. Legislation passed earlier by the House also has a a government option, with no state opt-out provision; it would have to be reconciled with any Senate-passed measure before a final bill could go to Obama's desk.

Senate considers amendments to health bill - Capitol Hill- msnbc.com