WASHINGTON — The Senate voted Thursday to reinvent the nation’s health care system, passing a bill to guarantee access to health insurance for tens of millions of Americans and to rein in health costs as proposed by President Obama.
The 60-to-39 party-line vote, on the 25th straight day of debate on the legislation, brings Democrats a step closer to a goal they have pursued for decades. It clears the way for negotiations with the House, which passed a broadly similar bill last month by a vote of 220 to 215.
When the roll was called at 7:05 a.m. on Thursday, it was a solemn moment. Senators called out “aye” or “no.” Senator Robert C. Byrd, the 92-year-old Democrat from West Virginia, deviated slightly from the protocol.
“This is for my friend Ted Kennedy,” Mr. Byrd said. “Aye!”
If the two chambers can strike a deal, as seems likely, the resulting product would vastly expand the role and responsibilities of the federal government. It would, as lawmakers said repeatedly in the debate, touch the lives of nearly all Americans.
The bill would require most Americans to have health insurance, would add 15 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $871 billion over 10 years, according to the Congressional Budget Office.
The budget office estimates that the bill would provide coverage to 31 million uninsured people, but still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants.
If the bill becomes law, it would be a milestone in social policy, comparable to the creation of Social Security in 1935 and Medicare in 1965. But unlike those programs, the new initiative lacks bipartisan support. Only one Republican voted for the House bill last month, and no Republicans voted for the Senate version.
Senator Olympia J. Snowe of Maine, a moderate Republican who has spent years working with Democrats on health care and other issues, expressed despair.
“I was extremely disappointed,” Ms. Snowe said. After Senate Democrats locked up 60 votes within their caucus, she said, “there was zero opportunity to amend the bill or modify it, and Democrats had no incentive to reach across the aisle.”
Like many Republicans, Ms. Snowe was troubled by new taxes and fees in the bill, which she said could have “a dampening effect on job creation and job preservation.” The bill would increase the Medicare payroll tax on high-income people and levy a new excise tax on high-premium insurance policies, as one way to control costs.
The fight on Capitol Hill prefigures a larger political battle likely to play out in the elections of 2010 and 2012, as Democrats try to persuade a skeptical public of the bill’s merits, while Republicans warn that it will drive up costs for those who already have insurance.
After struggling for years to expand health insurance in modest, incremental ways, Democrats decided this year that they could not let another opportunity slip away.
As usual, lawmakers were deluged with appeals from lobbyists for health care interests who have stymied similar ambitious efforts in the past. But this year was different.
Lawmakers listened to countless stories of hardship told by constituents who had been denied insurance, lost coverage when they got sick or seen their premiums soar. Hostility to the health insurance industry was a theme running through the Senate debate.
Senator Sherrod Brown, Democrat of Ohio, said insurance companies were often “just one step ahead of the sheriff.”
Senator Dianne Feinstein, Democrat of California, said the industry “lacks a moral compass.”
“Premiums are out of hand,” Mrs. Feinstein said. “Chief executive salaries are out of hand. Administrative costs are out of hand. My bottom-line belief is that the health insurance industry should be nonprofit.”
And Senator Sheldon Whitehouse, Democrat of Rhode Island, said the business model of the health insurance industry deserved to die.
“It deserves a stake through its cold and greedy heart,” Mr. Whitehouse said.
The bill would establish stringent federal standards for an industry that, since its inception, has been regulated mainly by the states.
Under the bill, insurers could not deny coverage because of a person’s medical condition; could not charge higher premiums because of a person’s sex or health status; and could not rescind coverage when a person becomes sick or disabled. The government would, in effect, limit the profits of insurers by requiring them to spend at least 80 to 85 cents of every premium dollar on medical care.
The specificity of federal standards is illustrated by one section of the bill, which requires insurers to issue a summary of benefits that “does not exceed four pages in length and does not include print smaller than 12-point font.”
Another force propelling health legislation through the Senate was the Democrats’ view that it was a moral imperative and an economic necessity.
“The health insurance policies of America, what we have right now is a moral disgrace,” said Senator Tom Harkin, Democrat of Iowa, who noted that medical expenses had driven many people into bankruptcy. “We are called upon to right a great injustice, a great wrong that has been put upon the American people.”
Costs of the bill would, according to the Congressional Budget Office, be more than offset by new taxes and fees and by savings in Medicare. The measure would squeeze nearly a half-trillion dollars from Medicare over the next 10 years, mainly by reducing the growth of payments to hospitals, nursing homes, private Medicare Advantage plans and other health care providers.
Republicans asserted that the cuts would degrade services to Medicare beneficiaries. But AARP, the influential lobby for older Americans, and the American Medical Association ran an advertisement urging senators to pass the bill, under which Medicare would cover more of the cost for prescription drugs, screenings and other preventive health services.
Karen M. Ignagni, president of America’s Health Insurance Plans, said the bill appeared to be unstoppable. But she added: “We are not sure it will be workable. It could disrupt existing coverage for families, seniors and small businesses, particularly between now and when the legislation is fully implemented in 2014.”
The bill would set up insurance exchanges where people could compare health plans and buy insurance with tax credits to help cover the cost.
Whether such plans should be allowed to cover abortion is perhaps the most difficult issue that will face Senate and House negotiators.
Architects of the legislation said they wanted to move away from the fragmented fee-for-service health care system, toward one in which doctors and hospitals would coordinate care and take collective responsibility for patients, with payments based more on the quality of care and less on the volume of services.