WASHINGTON – Senate Democrats confidently advanced health care legislation Sunday toward a make-or-break test vote in a push for Christmas-week passage. Republicans vowed to resist what they appeared unable to stop.
“This process is not legislation. Democratic Sen. Sheldon Whitehouse of Rhode Island responded in near-Biblical terms. Whatever else it was, the legislation represented the culmination of a year’s work for Democrats, pressed by President Barack Obama to remake the nation’s health care system.
Under Senate rules, Democrats needed 60 votes on three separate occasions to pass the measure. Democrats said Nebraska Sen. Ben Nelson’s announcement Saturday that he would vote for the bill gave them the support they needed.
Nelson came in for strong criticism from Republicans in Washington, who complained that he had won favorable treatment for his home state’s Medicaid program. Asked if Republicans could prevent the bill’s passage, Sen. John McCain, R-Ariz., said: “Probably not. Democrats hoped Republicans would relent in the face of a clear 60-vote majority, but if GOP critics choose to do so, they could delay a final vote on the bill until early Christmas Eve.
The Senate legislation is predicted to extend coverage to more than 30 million Americans who lack coverage and would ban industry practices such as denial of insurance on the basis of pre-existing medical conditions. In a bow to Senate moderates, the measure lacks a government-run insurance option of the type that House Democrats placed in their bill. Instead, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for privately owned, nonprofit nationwide plans overseen by the same federal agency office that supervises the system used by federal employees and members of Congress.
Nelson won numerous changes, including tougher restrictions on abortion coverage and an estimated $45 million in federal Medicaid funds, enough to completely cover his state’s costs of complying with an expansion of the program mandated by the bill.
It was only a few weeks before Massachusetts Sen. Edward M. Kennedy, a longtime advocate of universal health care, succumbed after a long battle with brain cancer and Democrats reverted to 59 seats.

With a heavy push from Reid and the White House, and a request Kennedy wrote not long before his death, Democrats in the Massachusetts Legislature quickly changed state law so Gov. Deval Patrick could appoint a temporary replacement.

Associated Press reporter Margery Beck contributed to this story from Omaha, Neb.

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