WASHINGTON — Senate Democrats passed a landmark health care bill in a climactic Christmas Eve vote that could define President Barack Obama’s legacy and usher in near-universal medical coverage for the first time in the country’s history.
“We are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people,” Obama said shortly after the Senate acted.

“This will be the most important piece of social legislation since Social Security passed in the 1930s,” said Obama, standing with Vice President Joe Biden in the State Room of the White House.
The 60-39 vote on a cold winter morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Biden presided as 58 Democrats and two independents voted “yes.” Republicans unanimously voted “no.”
An exhausted Senate Majority Leader Harry Reid, D-Nev., initially cast a “no” vote by mistake, then quickly corrected himself as fellow senators burst out laughing.
The tally far exceeded the simple majority required for passage.
The Senate’s bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures but Democrats say they’ve come too far now to fail.
Both bills would extend health insurance to more than 30 million more Americans. Obama said the legislation “includes the toughest measures ever taken to hold the insurance industry accountable.”
Deputy White House press secretary Bill Burton, speaking to reporters aboard Air Force One as Obama flew to Hawaii, said the House and Senate versions were “95 percent similar.”
“We’re going to be actively working to iron out the rest of the differences and get a bill passed and signed,” Burton said.
Vicki Kennedy, the widow of Sen. Edward M. Kennedy, D-Mass., who made health care reform his life’s work, watched the vote from the gallery. So did Rep. John Dingell, D-Mich., the longest-serving House member and a champion of universal health care his entire career.
“This morning isn’t the end of the process, it’s merely the beginning. We’ll continue to build on this success to improve our health system even more,” Reid said before the vote. “But that process cannot begin unless we start today ... there may not be a next time.”
At a news conference a few moments later, Reid said the vote “brings us one step closer to making Ted Kennedy’s dream a reality.”
The Nevadan said that “every step of this long process has been an enormous undertaking.”
Sen. Max Baucus, D-Mont., chairman of the Finance Committee, said he “very happy to see people getting health care they could not get.”
It was the Senate’s first Christmas Eve vote since 1895, when the matter at hand was a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.
After the vote Obama offered congratulations in phone calls to Vicki Kennedy and Reid, Baucus and other senators, including 92-year-old Robert Byrd, D-W.Va., who was brought to the Senate in a wheelchair.
The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation’s health care system than any of their predecessors.
The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions, beginning in 2014 in the Senate version, and 2013 in the House measure. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.
For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties. The legislation costs nearly $1 trillion over 10 years and is paid for by a combination of taxes, fees and cuts to Medicare.
Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, contended Minority Leader Mitch McConnell, R-Ky., “they wouldn’t be rushing it through Congress on Christmas Eve.”
House Minority Leader John Boehner assailed the bill moments after passage.
“Not even Ebenezer Scrooge himself could devise a scheme as cruel and greedy as Democrats’ government takeover of health care,” the Ohio Republican said in a statement.
“Sen. Reid’s health care bill increases premiums for families and small businesses, raises taxes during a recession, cuts seniors’ Medicare benefits, adds to our skyrocketing debt, and puts bureaucrats in charge of decisions that should be made by patients and doctors,” he said.
The occasion was moving for Sen. Paul Kirk, D-Mass., appointed to fill Kennedy’s seat after his death in August.
“He’s having a merry Christmas in heaven,” Kirk told reporters after the tally. He said he was “humbled to be here with the honor of casting essentially his vote.”
Said Dingell: “This is for me, this is for my dad, this is for the country.” Dingell’s father, John Dingell Sr., labored for health care legislation when he served in Congress from the 1930s until his death in 1955.
Reid nailed the last votes down in a rush of dealmaking in the last week that is now coming under attack because of special provisions obtained by a number of senators. In Nebraska, home to conservative Democrat Ben Nelson, the Democrats’ crucial 60th vote, the federal government will pay 100 percent of the cost of a planned Medicaid expansion in perpetuity, the only state getting that deal.
Negotiations between the House and Senate to reconcile differences between the two bills are expected to begin as soon as next week. The House bill has stricter limits on abortion than the Senate, and unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion. Obama has signaled he will sign a bill even if it lacks that provision.