 The United States Senate has approved a hard-fought measure to overhaul the health care system. The vote will be followed by the difficult process of reconciling the Senate-passed bill with one approved by the House of Representatives, in order to get a final measure to President Barack Obama.
"The yeas are 60, the nays are 39. H.R. 3590 as amended, the Patient Protection and Affordable Care Act is passed," Vice President Joe Biden announced. Senator Jim Bunning of Kentucky did not show up for the vote leading to the 39 nays. Mike Reynard, a spokesman for Bunning, said in an e-mail that "The senator had family commitments." 
The vice president presided over the Senate at the time of the vote in his role as President of the United States Senate.
As expected, Republicans voted against the bill while all Democrats and two Independents, Joe Lieberman of Connecticut and Bernie Sanders of Vermont, voted for it.
At an estimated $87 billion, the measure would expand health insurance coverage to about 30 million more Americans currently without it, and create new private insurance marketplaces, or exchanges, to expand choice.
And, like the slightly more expensive measure passed by the House of Representatives, the Affordable Health Care for America Act, it would end a practice by private insurance companies of denying coverage to individuals with existing health problems. 
Both the Senate and House measures would require nearly all Americans to purchase some form of insurance, while lower-income Americans would receive help from federal government subsidies.
—Senator Harry Reid, Senate Majority LeaderIn remarks before the vote, Senate Majority Leader Harry Reid, Democrat from Nevada, said opponents had done everything they could to prevent the vote from taking place.
Speaking to reporters, Reid and others hailed the vote as a victory and a major step toward providing millions more Americans with access to health care. "This is a victory because we have affirmed that the ability to live a healthy life in our great country is a right and not merely a privilege for the select few," Reid said.
Reid and others including Robert Byrd, the 92-year-old Democrat from West Virginia, paid tribute to Senator Edward Kennedy, who died this past August after spending decades of his career in the Senate pursuing health care reform.
When casting his vote Byrd said, "Mr. President, this is for my friend Ted Kennedy. Aye." 
Victoria Reggie Kennedy, the widow of Senator Kennedy, watched the proceedings from the Senate visitor's gallery, as did Representative John Dingell, Democrat from Michigan, who has been a long time advocate of health care reform and who sponsored and introduced the House version of the health care reform bill.
In the final hours of debate on the Senate bill, Republicans asserted it would be ineffective and add sharply to the U.S. budget deficit.
—Senator Robert ByrdSenator Jeff Sessions, Republican from Alabama said of the bill, "This legislation may have a great vision, it may have a great idea about trying to make the system work better. But it does not. These are huge costs [and] it's not financially sound."
Senate Minority Leader Mitch McConnell vowed to defeat the bill when the Senate reconvenes in January saying, "This fight is not over. This fight is long from over. My colleagues and I will work to stop this bill from becoming law." 
Senator Olympia Snowe, a moderate Republican from Maine who helped approved the Senate Finance Committee's version of health care reform, the America's Healthy Future Act, earlier in the year and who remarked she may not vote on the final bill, said, "I was extremely disappointed," noting that when the Democrats reached their needed 60 votes to overcome a filibuster, "there was zero opportunity to amend the bill or modify it, and Democrats had no incentive to reach across the aisle." 
Ahead are difficult negotiations with the House of Representatives to craft a final bill President Obama would sign into law. These talks, which will formally get under way early in the new year, will take place amid anger among many liberal House Democrats the Senate bill failed to contain a government-run public health insurance option.
—Senator Mitch McConnell, Senate Minority LeaderMembers of the House Progressive Caucus have vowed to fight to keep this public option in any final legislation that emerges, along with other provisions they say are needed to protect lower and middle-income Americans and hold insurance companies accountable.
In a statement, the Democratic chairmen of three key House committees said while there are clear differences between House and Senate bills, both will bring fundamental health care coverage to millions who are currently uninsured. 
Obama administration officials have been quoted as saying they anticipate negotiations on a final bill would not be complete until after the President's State of the Union Address in January, and could slip even later into the new year. 
—President Barack ObamaPresident Obama issued a statement to the press in the State Dining Room in the White House saying that the vote is "legislation that brings us toward the end of a nearly century-long struggle to reform America's health care system."
He also pointed out the bill's strengths, noting, "The reform bill that passed the Senate this morning, like the House bill, includes the toughest measures ever taken to hold the insurance industry accountable.  Insurance companies will no longer be able to deny you coverage on the basis of a preexisting condition.  They will no longer be able to drop your coverage when you get sick.  No longer will you have to pay unlimited amounts out of your own pocket for the treatments you need.  And you'll be able to appeal unfair decisions by insurance companies to an independent party."
He also noted how historic the bill is, saying, "If passed, this will be the most important piece of social policy since the Social Security Act in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s."
Obama noted the potential social impact, saying, "It's the impact reform will have on Americans who no longer have to go without a checkup or prescriptions that they need because they can’t afford them; on families who no longer have to worry that a single illness will send them into financial ruin; and on businesses that will no longer face exorbitant insurance rates that hamper their competitiveness."
Obama afterwards made phone calls to various Senators and other people, including Victoria Kennedy and David Turner of Little Rock, Arkansas. Mr. Turner had his health insurance rescinded in January of last year, after his insurance company went back into his record and alleged that he failed to disclose his full medical record at the time he applied for coverage. Turner was First Lady Michelle Obama's guest during her husband's speech to a joint session of Congress on health care reform back in September.

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U.S. Senate passes landmark health care reform bill