WASHINGTON A broad healthcare overhaul was poised to clear its first Senate hurdle on Saturday as the last wavering senators said they would vote to begin debate on the legislation, giving Democrats the 60 votes they need.
Democrats Blanche Lincoln and Mary Landrieu ended days of uncertainty and said they would support a procedural motion on Saturday to open debate to reform the $2.5 trillion healthcare system -- the Senate bill's first crucial test vote.
The healthcare overhaul, President Barack Obama's top domestic priority, would expand coverage to millions of uninsured and bar insurance practices like denying coverage to those with pre-existing conditions.
The stakes are high for Obama in the healthcare debate, with his political standing and legislative agenda on the line less than a year into his first term.
Democrats need 60 votes to approve the motion in the 100-member Senate and have no margin for error -- they control exactly 60 votes and Republicans are united in opposition.
Landrieu and Lincoln, moderates from conservative Southern states where the overhaul is unpopular, were the last uncommitted Democrats on the 8 p.m. EST vote.
Both went to the Senate floor to say they wanted the debate to begin, but they could not commit to supporting the final bill without changes.
"Although I don't agree with everything in this bill, I have concluded that 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.
Landrieu said she wanted changes to make healthcare more affordable, ease the burden on small businesses and rein in the growth of costs.
"There are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done before I can support this effort," she said.
Landrieu and Lincoln had been showered with attention by Senate Democratic leader Harry Reid and Obama administration officials as they pondered their vote.
LANDRIEU DEFENDS FUNDING
In her floor speech, Landrieu defended her successful effort to win more funds in the bill for Medicaid, the government health program for the poor, for her home state of Louisiana.
"I am proud to have fought for it. I will continue to. But that is not the reason I am moving to debate," she said.
Republicans have condemned the healthcare bill as a costly government intrusion in the private sector that would raise insurance premiums, reduce consumer choices and raise taxes.
Republican Senate leader Mitch McConnell said some Democrats had to "twist themselves into a pretzel" to justify voting to move ahead on the bill. Almost all Senate bills that clear the first hurdle eventually pass, he said.
"The easiest time to change this bill, if you were serious about it, is right now," he told reporters. "The time of maximum leverage would have been before tonight's vote."
Reid said he just wanted to get the debate started on the 2,074-page plan he unveiled on Wednesday after weeks of closed-door negotiations. "Why would anybody be afraid, in the greatest debating society supposedly in the world, to debate healthcare?" he asked.
Once the Senate takes up the bill, the debate is expected to begin on November 30 and last at least three weeks, making it unlikely Obama can sign a final bill by the end of the year.
McConnell said Republicans would use every weapon possible to slow down the debate and try to block the bill. "The battle has just begun," he said.
Any differences between a Senate bill and the version passed earlier this month by the House of Representatives would have to be reconciled -- a potentially difficult task -- before the final measure can be voted on again in both houses and sent to Obama.
The legislation would spark the biggest changes in the healthcare system -- which accounts for one-sixth of the U.S. economy -- since the 1965 creation of the Medicare government health insurance plan for the elderly.
The Senate bill would require all Americans to buy insurance and would set up exchanges where they could choose among various options. It would offer subsidies to help low-income workers pay for the coverage.
Republicans have criticized its tax increases to help pay for the expanded insurance coverage. It would 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.
(Additional reporting by Jeremy Pelofsky; Editing by Vicki Allen and Sandra Maler)