President Barack Obama may get one of his Christmas wishes this year as the Senate took the first steps to advance its comprehensive health reform bill.

At 1 a.m. today (Dec. 21), the Senate voted 60-40 to close debate on its 10-year, $871 billion health bill and advance it to a series of approval votes with the goal of wrapping up the issue by Christmas Eve. The vote fell among party lines, with all 58 Democrats and the Senate’s two independents voting in favor of advancing the bill and all 40 Republicans voting in opposition.

Harry Reid

Shortly after the vote, Senate Majority Leader Harry Reid (D-Nev.), who also authored the Patient Protection and Affordable Care Act, said the vote to end debate on the manager’s amendment – the package of arrangements including the omission of a public option to achieve a Democratic consensus – was a “historic step.”

Reid said the measure will cut the deficit by $132 billion over the next 10 years while providing health care to an additional 31 million currently uninsured Americans, according to estimates by the Congressional Budget Office.

“Senate Democrats are determined to not let the American people down because we know the cost of inaction,” Reid said in a statement. “Almost 8,000 Americans lose their health insurance every day that we do not act. That’s why I’ve been so disappointed with the ‘do nothing, say anything’ approach that most Senate Republicans have decided to take toward health reform. Despite their decision to bet on failure, Senate Democrats are committed to passing health legislation this week that will deliver quality, affordable health coverage for all Americans.”

With the vote to advance the bill behind them, senators will now take formal votes on closing debate on whether to add the compromise language into the text of the bill, expected Dec. 22, and to close debate on the entire bill altogether, a vote expected to come Dec. 23. The votes are largely procedural, meaning passage in the Senate is all but assured.

‘One of the major reforms of the 21st century’

Getting all 60 Democrats to sign off on the bill was attained late Saturday, with the blessing of Sen. Ben Nelson of Nebraska, who was holding back his approval amid concerns including the use of federal funds for abortion.

Ben Nelson

In a statement announcing his support for the Senate bill, Nelson said he had assurances that his concerns on the use of tax dollars for abortions and the rights of states to regulate the kinds of insurance offered were addressed adequately.

“I know this is hard for some of my colleagues to accept,” he said. “And I appreciate their right to disagree. But I would not have voted for this bill without these provisions.

“I truly believe this legislation will stand the test of time and will be noted as one of the major reforms of the 21st century; much like social security, Medicare and civil rights legislation were milestones of the 20th century,” Nelson added. “Because of Senator Reid’s dedication and hard work, the lives of tens of millions of Americans will be improved, lives will be saved, and our health care system will once again reflect the better nature of our country. “

While Nelson was praising his party’s concessions, Sen. John McCain (R-Ariz.) was denouncing it, alluding to Democrats securing their lone holdout’s vote with a reported deal to add $45 million in Medicaid funding for Nelson’s constituents in Nebraska.

Appearing on Fox News Sunday Dec. 20, McCain said that Nelson’s deal would put an “added burden” on all other states, but there was a bigger problem at hand.

“I think the real problem here and the situation that we have gotten ourselves in is the president of the United States said when running, we would have a new way of doing business in Washington, there would be change, he would negotiate across the table, we’d have the C-SPAN cameras in and, obviously, with their majorities and I understand majorities, they decided to govern from the left and without Republican participation,” McCain said. “That’s why they’re in a position of having to purchase the last vote or two.”

The veteran senator added that American public opinion is against the Senate’s health plan and that Republicans will “fight the good fight” and “fight until the last vote.”

Insurer’s get last-minute reprieve

The Senate bill must still be reconciled with its companion passed in the House earlier this year. The two bills have their share of differences, including the inclusion of a government-run health insurance program or “public option.”

While the Senate version leans more toward expanding Medicare rather than creating a new program, the House bill creates a public plan to compete with private insurers.

While private insurance companies await the fate of the public option, they did score a small victory in the Senate with a vote to defer for a year the excise tax on their operations.

A measure proposed by Reid deferred the payment, estimated at about $6.7 billion annually, and exempted some nonprofit insurers from the tax. Among the requirements that companies must meet to be exempt are achieving a medical loss ratio of 92%, meaning that percentage of premium goes directly to health care expenses, according to the Wall Street Journal.

Another stipulation to qualify for exemption is providing guaranteed-issue coverage to those who cannot obtain insurance coverage elsewhere, the newspaper reported.