Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.
At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.
The House approved its version of the bill earlier this month on a near party line vote of 220-215, and Reid has said he wants the Senate to follow suit by year's end. Timing on any final compromise was unclear.
All 58 Senate Democrats and two independents voted to advance the bill. All 39 votes in opposition were cast by Republicans. GOP Sen. George Voinovich of Ohio was the only senator not to vote. Montana Sen. Max Baucus, the chairman of the Senate Finance Committee who has labored on health care for more than a year, flew in from his home state on a government plane for the vote and was returning afterward to be with his ailing mother.
While timing made Landrieu and Lincoln the final two Democrats to announce their intentions, Sen. Paul Kirk of Massachusetts had a clear claim as the 60th vote.
Appointed to office this fall after the death of Kennedy, who championed health care issues for decades, Kirk said he spoke for those "who for so many years revered and loved and elected and re-elected (him) ... that I think they're all — they all, as we do, have him in our minds and our hearts tonight. ..."
Sen. Chris Dodd, D-Conn., echoed those sentiments later in the evening when he referred to Kennedy's "lifelong quest" for national health care and said "tonight and in the days to come we will pay him the highest compliment by fulfilling that" goal.
At a post-vote news conference, Reid said he had telephoned Kennedy's widow, Vicki, with the news.
In hours of debate before the Saturday evening vote, a few Republicans piled copies of the 2,074-page bill on their desks while others criticized it as a government takeover of health care and worse.
"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., likening the bill's supporters to the imprisoned investor who fleeced millions.
In her remarks, Landrieu said, "I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done." She also touted the $100 million included in the legislation to help her state cover its costs under Medicaid, the state-federal health care program for the poor.
Lincoln referred repeatedly to the political controversy surrounding the issue. She said $3.3 million has already been spent by outside groups advertising either for or against health care legislation in her state, and said, "these outside groups seem to think that this is all about my re-election. I simply think they don't know me very well."
To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments. Hardest hit would be the private insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.
The bill raises payroll taxes on incomes over $200,000 for individuals and $250,000 for couples. Reid eased the impact of an earlier proposal to tax high-value insurance plans, which has emerged as one of the principal methods for restraining the growth in health costs.
The bill includes tax increases on insurance companies, medical device makers, patients electing to undergo cosmetic surgery and drugmakers.
