The Senate on Thursday passed the reconciliation bill to amend the health care reforms recently signed into law, bringing the health care debate one step closer to an end.
The package of changes passed by a vote of 56 to 43 and now goes to the House for a final vote. The House will take up the measure this evening.
"The American people have waited for this moment for a century," Senate Majority Harry Reid said after the vote.
Sen. Max Baucus, D-Mont., called the moment a "tectonic plate shift" for the nation.
Three Democrats sided with Republicans and voted against the measure: Sens. Blanche Lincoln (Ark.), Mark Pryor (Ark.) and Ben Nelson (Neb.). One senator missed the vote -- Johnny Isakson (R-Ga.) is hospitalized in Georgia with an infection.
The Senate would have been the final stop for the bill before President Obama's desk, but Senate Republicans learned early Thursday that they could kill some language in the measure. Even though the House passed the reconciliation bill on Sunday, they have to pass it again now that the language has been altered.
Democratic leaders say the changes are minor and passing the bill again in the House will not be a problem.
"Of all the things they could have sent back, this is probably the most benign, easily fixed," House Speaker Nancy Pelosi said on Thursday.
The president, into law on Tuesday, flew to Iowa Thursday for the first of many appearances he will make around the country before the fall congressional elections to sell his health care revamp.
Mr. Obama , where as a presidential candidate in 2007 he touted his ideas for health coverage for all. His trip coincided with polls showing people are divided over the new health law, and Democratic lawmakers from competitive districts hoping he can convince more voters by November that it was the right move.
"From this day forward," Mr. Obama said today, "all of the cynics and the naysayers will have to confront the reality of what this reform is and what it isn't."
A released Wednesday found that nearly two in three Americans said they wanted Republicans to continue challenging parts of the health care reform bill.
Republicans this week were hunting for ways to bring down the reconciliation bill. The minor provisions that had to be removed from the bill today related to Pell grants for low-income students.
Complete Coverage: Health Care Reform
Besides reshaping parts of the landmark health overhaul, the legislation transforms the federal student loan program - in which private banks distribute the money - into one in which the government issues the loans directly. That produces some federal savings, which the bill uses in part to increase Pell grants to needy students.
Democratic aides said the problematic provisions dealt with protecting students from future cuts in their grants if Congress does not provide enough money for them. They violated budget rules because they did not produce savings, one aide said.
The development came as the Senate completed nine hours of uninterrupted voting on GOP amendments to the legislation. Majority Democrats defeated every amendment.
The legislation would change the new health care law by making drug benefits for Medicare recipients more generous by gradually closing a gap in coverage, increasing tax subsidies to help low-income people afford health care, and boosting federal Medicaid payments to states.
It kills part of the new statute uniquely giving Nebraska extra Medicaid funds - designed to lure support from that state's Sen. Ben Nelson - that had become a glaring embarrassment to Democrats. It also eases a new tax on expensive health coverage bitterly opposed by unions and many House Democrats, while delaying and increasing a new levy on drug makers.
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As they began pushing the bill to passage on Wednesday afternoon, Democrats ran into a mountain of GOP amendments designed to slow passage of the legislation. Outnumbered and all but assured of defeat, Republicans forced votes on amendments aimed at reshaping the measure - or at least forcing Democrats to take votes that could be used against them in TV ads in the fall campaigns.
"There's no attempt to improve the bill. There's an attempt to destroy this bill," said an exasperated Majority Leader Reid.
"The majority leader may not think we're serious about changing the bill, but we'd like to change the bill, and with a little help from our friends on the other side we could improve the bill significantly," answered Senate Minority Leader Mitch McConnell, R-Ky.
Senators voted on 29 consecutive GOP amendments between 5:30 p.m. Wednesday and 2:30 a.m. Thursday, when they recessed. Resuming later in the morning, they voted on 12 more.
By 57-42, Democrats rejected an amendment by Sen. Tom Coburn, R-Okla., . Coburn said it would save millions, while Sen. Max Baucus, D-Mont., called it "a crass political stunt."
Democrats also deflected GOP amendments rolling back the health law's Medicare cuts; killing extra Medicaid funds for Tennessee and other state-specific spending; barring tax increases for families earning under $250,000; and requiring the president and other administration officials to purchase health care from exchanges the statute creates.
The landmark legislation that Mr. Obama signed Tuesday is expected to provide health care to 32 million uninsured people, and make coverage more affordable to millions of others by expanding the reach of Medicaid and creating new subsidies. Insurance companies will be forbidden to refuse coverage to people with pre-existing illnesses, individuals will be able to buy policies on newly created exchanges and parents will be able to keep children on their family plans until their 26th birthdays.
The $938 billion, 10-year price tag will be financed largely by culling savings from Medicare and imposing new taxes on higher income people and the insurance, pharmaceutical and medical device industries.
Details of the Bill:
Uninsured? What the New Bill Means for You
Already Insured? Get Ready to Pay More
Health Reform Tweaks Seniors' Medicare
Feds Eye Big Savings from Health Reform
How Health Reform Affects Small Businesses
Read the Text (PDF): Complete Senate Bill | Reconciliation Measure