WASHINGTON Senate Democrats moved closer on Monday to passing landmark healthcare legislation by Christmas after scoring a win in the first big test vote and gaining the support of a powerful lobbying group for doctors.
In a middle-of-the-night vote in the snowy U.S. capital, Democrats rounded up 60 votes to clear a crucial Republican procedural hurdle and put a broad revamp of the healthcare system on a path for passage on Christmas Eve.
"The Senate has moved us closer to reform that makes a tremendous difference for families, for seniors, for businesses, and for the country as a whole," said President Barack Obama.
The vote early on Monday was the first test of whether Democrats could stick together to secure the 60 votes needed to overcome unified Republican opposition and muscle changes to the healthcare system through the Senate.
The healthcare overhaul, Obama's top legislative priority, faces two more procedural tests with a 60-vote threshold -- on Tuesday morning and Wednesday afternoon -- before a vote on final passage now scheduled for Thursday night.
"We'll get this passed before Christmas and it will be one of the best Christmas presents this Congress has ever given the American people," said Democratic Senator Tom Harkin.
The influential American Medical Association, the largest doctors' group with 250,000 members, endorsed the Senate legislation and said it would provide significant reform.
"This bill advances many of our priority issues for achieving the vision of a health system that works for patients and physicians," AMA President-elect Cecil Wilson told reporters at a news conference with Democratic senators.
The House of Representatives passed its own version of healthcare legislation on November 7.
Once the Senate passes its bill, lawmakers must iron out differences between the competing versions, a negotiation expected to begin in January, and both chambers would have to pass the measure again before sending it to Obama to sign.
Among the toughest issues in the merger will be a government-run insurance option included in the House bill but dropped by the Senate to appease moderate Democrats. There are also competing versions of language barring the use of federal funds to pay for abortions.
Given the difficulties winning Senate passage, it will be difficult for the final measure to stray far from the Senate version. Senate Democratic leader Harry Reid said he was not worried yet about negotiations with the House.
"We have to pass this bill in the Senate first," Reid said. "We'll worry about the next step at a later time."
Republicans acknowledged they cannot stop the Senate bill, which would lead to the biggest changes in the $2.5 trillion U.S. healthcare system since the 1965 creation of the Medicare health program for the elderly.
The Senate bill would require most Americans to have insurance, extend coverage to 30 million uninsured and give subsidies to help some pay for it. It would also halt industry practices like refusing insurance to people with pre-existing medical conditions.
The non-partisan Congressional Budget Office says the Senate bill would cost $871 billion over 10 years and cut the federal deficit by $132 billion over the same period, meeting Obama's goals.
Healthcare shares rose as it became clear the bill was headed to final passage. Investors seemed pleased that the Senate version does not include a government-run insurance plan that private health insurers oppose and that it delays a $6.7 billion industry tax one year to 2011.
"All in all, relative to the last version of health reform issued by the Senate, things have turned out pretty well for the health insurance industry," said Carl McDonald, an analyst at Oppenheimer.
The S&P Managed Health Care index closed 2.93 percent higher, nearly triple the gain in the broader market.
Democrats were assured of victory after their last holdout, Senator Ben Nelson, agreed to a compromise aimed at ensuring federal funds are not used to pay for abortions and sending extra healthcare money to his home state of Nebraska.
The House bill includes more restrictive abortion language, and advocates on both sides have criticized the Senate compromise. Nelson said he will oppose the combined bill if it changes his abortion deal or reinstates the government-run insurance option.
The loss of even one Democrat would sink the plan in the 100-member Senate. Democrats control 60 votes, the exact number needed to overcome united Republican opposition.
The bitter healthcare debate has consumed the U.S. Congress for months and placed Obama's political standing and legislative agenda on the line less than a year into his first term.
Obama has asked the Senate to finish by the end of the year to prevent the issue from spilling into the November 2010 congressional election campaigns. Most opinion polls show the bill losing public support, with majorities now opposed to it.
A CNN poll issued on Monday showed backing for the Senate healthcare bill has risen 6 percentage points since early in the month, although a majority still disapproves.
Monday's vote formally cut off debate on an amendment offered by Reid that made the final changes needed to win the support of all 60 Democrats. Democrats hope Republicans will surrender once Democrats prevail in the three procedural test votes that require a 60-vote threshold.
If Republicans insist on using all of their allotted time under Senate rules, they can delay the final vote until late on Christmas Eve. That vote requires only a simple majority.
"We are not going to give up after this vote, believe me," Republican Senator John McCain said.
(Additional reporting by Alister Bull; Editing by Will Dunham and Chris Wilson)