Changes closer after Senate vote

WASHINGTON — The Senate's 60-39 vote early Thursday to overhaul the nation's health care system — President Obama's top 2009 domestic priority — moves the nation closer than it has ever been to a dramatic change in how Americans get medical care.

"We may not completely cure this crisis today or tomorrow," said Senate Majority Leader Harry Reid, D-Nev., "but we must start toward that end."

At the White House, Obama declared that, "With today's vote, we are now incredibly close to making health insurance reform a reality in this country. These are not small reforms. These are big reforms."

Despite all the compromises — and more to come as the Senate and House of Representatives try to reconcile their differing versions of the legislation — Obama put a positive spin on the effort. If the changes become law, he said, they would be the biggest social reform since the creation of Social Security in the 1930s.

Fifty-eight Democrats and two independents — but none of the Senate's 40 Republicans — voted for the $871 billion bill, which would require most Americans to obtain health insurance, would provide federal aid for those who have difficulty paying for coverage and would bar insurers from denying policies to people with pre-existing conditions.

The bill now must be merged with a version the House passed last month. Negotiators are likely to begin closed-door talks next month, aiming to finish a final compromise bill in time for Obama's State of the Union address, in late January.

Some major differences need to be resolved before any bill can emerge from the House-Senate conference, however.

Democratic leaders and the White House are confident that they can find common ground, and they say they see plenty already. Insurance exchanges, or marketplaces, would be created in which consumers could shop for policies, for instance. Companies no longer could charge higher rates because of gender, and they'd be limited in how much more they could charge older consumers.