The Senate voted 60-39 Saturday to clear the way for consideration of historic legislation to overhaul the nation's health-care system, but reluctant Democratic moderates sent strong signals that the bill has an uncertain future.


Saturday's test vote was about whether to cut off a Republican-led filibuster and begin formal debate on the Senate Democrats' proposed $848 billion, 2,074-page health care plan.

Democrats control 60 of the Senate's 100 seats, and all 60 voted to proceed with the bill, while 39 of the 40 Republicans voted no. Ohio Republican George Voinovich didn't vote, while the last Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, agreed Saturday afternoon to vote with their party.

Like other Democratic centrists who voted yes on the procedural test, however, Lincoln and Landrieu offered lukewarm assessments of the bill, reminders that eventual passage of President Barack Obama's top domestic priority is far from assured.

"Let me be perfectly clear," Lincoln said in a Senate floor speech. "I am opposed to a new government-administered health care plan as part of comprehensive health insurance reform."

While she said she was willing to keep the debate going, "I will not vote in favor of the proposal that has been introduced by (Senate Majority) Leader (Harry) Reid as it is written."

Landrieu had similar thoughts. "My vote today to move forward on this important debate should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end," she said.

Landrieu said she backed keeping the process going because, "I've decided there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done."

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Landrieu insisted that her vote wasn't motivated by the inclusion in the bill of a provision to provide an estimated $300 million in aid to her state's Medicaid program, which provides coverage for the poor.

Landrieu addressed the controversy in her floor speech. "I'm proud to have asked for it. I'm proud to have fought for it and will continue to. That's not the reason I'm moving to debate."

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The bill, unveiled Wednesday by Reid of Nevada and other Democratic leaders, would bar insurers from denying coverage because of pre-existing conditions; set up health exchanges, or marketplaces, where some consumers could shop for coverage; and create a government-run health-care plan, or public option. States could choose not to participate.

Landrieu and Lincoln weren't alone among Democrats in expressing strong reservations about aspects of the bill.

Sen. Ben Nelson, D-Neb., has questions about the bill's cost, while Landrieu said she wants more tax breaks for small businesses.

Lincoln, too, said she's wary of the bill's cost. "I believe that we should work to make sure that we do not expose American taxpayers and the Treasury to long-term risk that could occur over future bailouts of a public plan," she said.

Now that the Senate has cleared the way, it's expected to start considering the health care bill during the week of Nov. 30. Saturday's debate was essentially a preview of what's ahead, and it illustrated how divided the two political parties are on a range of issues.

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"The country suffers when there's a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," said Senate Judiciary Committee Chairman Patrick Leahy, D-Vt. "This is a defining moment for the Senate and the country."

Republicans battled back.

"Make no mistake, the Democrat plan we'll vote on tonight would make life harder for the vast majority of Americans," said Senate Republican Leader Mitch McConnell of Kentucky before the vote. "It raises their taxes. It raises their health care premiums. It cuts their Medicare. And it drives millions off of the private insurance they currently have."

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The biggest Saturday flashpoint involved abortion, as opponents tried hard to make Saturday's vote a test vote on the issue.

The bill passed Nov. 7 by the House of Representatives puts strict limits on abortion, barring the use of federal funds except in cases of rape, incest or when the mother's life is endangered. The Senate bill is less restrictive.

Because of Senate rules, it probably would take 60 votes to dilute the bill's language, and as a result, said Sen. Mike Johanns, R-Neb., "This provision is either fixed now, or it won't be fixed."

Anti-abortion Democrats, though, weren't buying it, arguing that Saturday's vote on a procedural tactic wasn't the way to contest abortion policy.

"This is a health care bill. This isn't an abortion bill," Reid said.

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To Republicans, it's also a bill larded with higher taxes. The measure would increase the Medicare payroll tax by 0.5 percentage points for singles with wages of more than $200,000 and for couples that earn more than $250,000. It also would impose a 40 percent excise tax on insurance policies that cost more than $8,500 for singles and $23,000 for families.

"Paying for health care reform by placing additional financial burdens on American families and small businesses will only further impede our ability to compete in the global marketplace and, ultimately, our economic recovery," said Sen. George Voinovich, R-Ohio.