WASHINGTON - Democratic leaders secured the last votes needed to move ahead on historic health care reform legislation, clearing the way for a Saturday night showdown on President Barack Obama's top domestic policy initiative.
In long-awaited speeches, two centrist Democratic senators said they would stand with their party and vote "yes" on the crucial test procedural vote despite deep reservations with parts of the 2,074-page bill to remake the U.S. health care system.
"The truth is this issue is very complex. There is no easy fix and it's imperative that we build on what's already working in health care in America," Sen. Blanche Lincoln of Arkansas told her Senate colleagues.
Earlier, Sen. Mary Landrieu of Louisiana said she would vote "yes" on the procedural vote to determine whether debate can go forward on the Senate floor on Majority Leader Harry Reid's health care reform bill.
Democratic leaders were optimistic they now have the 60 votes needed in the 100-member Senate to go forward. The Senate's 40 Republicans are unanimously opposed.
"I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done," Landrieu said, with the 8 p.m. EST (0100 GMT) vote looming.
But the two moderate Democrats both cautioned that while they have agreed to allow debate to continue, their vote Saturday does not commit them to supporting the final bill.
At a 10-year cost approaching $1 trillion, Reid's legislation is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny benefits to people with preexisting medical conditions, and curtail the growth of spending on medical care nationally.
Almost everyone would be required to purchase insurance, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage.
During Saturday's debate on the bill, Democrats called a revamp of the nation's health care system long overdue. The U.S. is the only major developed country that does not provide comprehensive medical coverage for its people, and Obama campaigned on a promise to change that.
"The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," Sen. Patrick Leahy, a Vermont Democrat, said during the rare weekend session.
United in opposition, Republicans cast the bill as a costly government takeover of the health care system, built on budget gimmicks.
"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond of Missouri, referring to the mastermind of a multibillion-dollar Ponzi scheme.
The action in the Senate comes two weeks after the House of Representatives approved a health overhaul bill of its own on a 220-215 vote. Major health care reform legislation has now advanced further through Congress than at any time since the 1960s when the government-run Medicare health insurance program for seniors was enacted.
After the vote Saturday night, senators will leave for a Thanksgiving holiday recess. Upon their return, assuming Democrats prevail on Saturday's vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.
Democratic centrists from conservative states are particularly wary of provisions to have a government-run plan compete with private insurers to drive down coverage costs. Efforts to insert stricter language to bar federal funds from being used to cover abortions has also become a divisive issue.
Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions. If a compromise can be reached, it would then have to be approved by both chambers of Congress before a final package could land on Obama's desk to sign.
The House and Senate bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.
Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.
Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.