Democrats remained united as they started voting at sunrise Tuesday, pushing toward their goal of passing President Barack Obama's health care overhaul by Christmas.
With not a vote to spare, the Senate voted 60-39 to shut off debate on Majority Leader Harry Reid's version of the bill. An earlier vote to approve a 400-page package of changes that sealed Democratic support for the health care bill also passed 60-39, though only a simple majority was required. No Republicans voted in favor.
With partisan feelings running high, Reid appealed to senators to forgo personal attacks. Democrats must pass another 60-vote test Wednesday before they vote on final passage, expected to come on Christmas Eve.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
WASHINGTON (AP) - Exhausted but happy Democratic leaders began nudging their painstakingly crafted health care compromise a step closer to pre-Christmas passage with three votes that started as the sun rose Tuesday.
Only one requires the difficult tally of 60 senators, and the outcome of that vote - to overcome GOP opposition to the sweeping legislation - is preordained. Majority Leader Harry Reid, D-Nev., has herded 58 Democrats and two independents into line through a combination of wheedling, cajoling and dispensing special deals. The strategy has Republicans irate.
"That's not change you can believe in. That's sleazy," Sen. Lindsey Graham, R-S.C., told NBC's "Today" show Tuesday, just before the voting began.
Reid makes no apologies.
"I don't know if there's a senator that doesn't have something in this bill that was important to them, and if they don't have something in it important to them, then it doesn't speak well of them," Reid said Monday.
Graham cited the example of $100 million in the legislation to pay the full cost of a Medicaid expansion in Nebraska - home to Democratic Sen. Ben Nelson, the crucial 60th vote for the bill. Another concession, sought by Sen. Bill Nelson, D-Fla., exempts roughly 800,000 seniors in Florida from potential benefit cuts by private Medicare Advantage plans.
The 10-year, nearly $1 trillion plan would extend coverage to some 30 million uninsured Americans, with a new requirement for almost everyone to purchase insurance. Subsidies would be provided to help lower-income people do so, and businesses would be encouraged to cover their employees through a combination of tax breaks and penalties.
Unpopular insurance company practices such as denying coverage to people with existing health conditions would be banned. Uninsured or self-employed Americans would have a new way to buy health insurance, via marketplaces called exchanges where private insurers would sell health plans required to meet certain minimum standards.
The legislation will make a "tremendous difference for families, for seniors, for businesses and for the country as a whole," Obama said Monday.
The American Medical Association announced its endorsement after Reid made some last-minute changes to please the doctors. A 5 percent tax on elective cosmetic surgery procedures was replaced with a 10 percent tax on indoor tanning services; a proposed fee on physicians to enroll in Medicare was dropped; and payment cuts to specialty and other physicians to pay for bonuses to primary care doctors in underserved areas were also eliminated, said the AMA's president-elect, Dr. Cecil B. Wilson.
"America has the best health care in the world - if you can get it," Wilson said at a press conference with Reid and other leaders. "For far too many people access to care is out of reach because they lack insurance. This is not acceptable to physicians."
Democrats prevailed 60-40 over Republican opposition on the first test early Monday, voting to block a threatened GOP filibuster of a last-minute package of Democratic amendments. Tuesday morning a simple majority will be required to approve the amendments, and then 60 votes to move to consideration of Reid's bill.
A final 60-vote hurdle awaits Wednesday, and final passage of the legislation - requiring a simple majority - is set for late Thursday, Christmas Eve, if Republicans take all the available time. As of Monday they said they would.
"I am willing to stay here. The flight that I have is Christmas morning, and I don't plan on changing that reservation," Sen. Bob Corker, R-Tenn., told reporters after a meeting of GOP senators. "We potentially are getting ready to pass a bill that there's no question in my mind is going to lead to huge deficits down the road."
The Senate measure would still have to be harmonized with health care legislation passed by the House before a final bill could go to Obama.