A sweeping healthcare overhaul narrowly cleared its first hurdle in the US Senate on Saturday, with Democrats casting 60 party-line votes to open debate on the biggest healthcare changes in decades.
In the first Senate test for President Barack Obama's top domestic priority, Democrats unanimously backed a procedural motion to open debate over the opposition of 39 Republicans. Republican George Voinovich did not vote. Democrats needed 60 votes to approve the motion in the 100-member Senate and had no margin for error - they control exactly 60 votes.
The Democratic victory was assured earlier in the day when the party's last two holdouts, Blanche Lincoln and Mary Landrieu, said they would support the motion but would not commit to backing the final bill without changes. "I believe that it is more important that we begin this debate to improve our nation's healthcare system for all Americans rather than just simply drop the issue and walk away," Lincoln said in a speech hours before the vote.
The debate will begin on November 30 and is expected to last at least three weeks. The House of Representatives has passed its own version, and differences in the two would have to be reconciled in January before Obama could sign a final measure. The healthcare reform bill would expand coverage to millions of uninsured and bar insurance practices like denying coverage to those with pre-existing conditions. The legislation would spark the biggest changes in the $2.5 trillion healthcare system - which accounts for one-sixth of the US economy - since the 1965 creation of the Medicare government health insurance plan for the elderly.
The stakes are high for Obama, with his political standing and legislative agenda on the line less than a year into his first term. White House spokesman Robert Gibbs said Obama was gratified by the vote and "looks forward to a thorough and productive debate." During a formal roll call, senators sat at their desks and called out their votes as their names were read. Visitors in the galleries cheered when the final tally was announced. The healthcare overhaul still faces significant challenges, with Senate Democratic leader Harry Reid trying to accommodate competing views in his party on issues like abortion, a government-run insurance plan and efforts to rein in costs.
Republicans also have vowed to delay or block the bill, which they condemned as a costly government intrusion in the private sector that would raise insurance premiums, reduce consumer choices and raise taxes.
Republicans have criticised its tax increases to help pay for the expanded insurance coverage. It would also raise the Medicare payroll tax on high-income workers, which is used to finance Medicare, and impose a tax on high-cost "Cadillac" insurance plans.
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