The House of Representatives

"Today we [decide] whether to even discuss one of the greatest issues of our generation," Reid, a Nevada Democrat, said shortly before the vote. "Whether this nation will finally guarantee its people the right to live free from fear of illness and death, which can be prevented by decent health care for all."

The Republicans "are frightening people," said Sen. Tom Harkin, D-Iowa. "Now is not the time to go wobbly in the knees. Now is the time to stand strong ... and move this country forward."

"This bill... is a massive monument to bureaucracy and spending," replied Senate Minority Leader Mitch McConnell, R-Kentucky. It "imposes punishing taxes on almost everyone. ... A vote in favor of proceeding to this bill is a vote in favor of adding to the tax burden of the American people in the midst of double digit unemployment." The bill "does worse than nothing," said Sen. Chuck Grassley, R-Iowa. It "threatens the economic recovery. ... Changes to the health care system must be responsible and not break the backs of the taxpayers."

The procedural vote represented another milestone in what has become an epic battle over the future of America's health care system.

The House of Representatives narrowly passed a more than $1 trillion bill this month. If the Senate also manages to pass a bill, a congressional conference committee will then need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to Obama's desk to be signed into law.

The nonpartisan Congressional Budget Office has projected that Reid's 2,074-page bill would extend health insurance coverage to 31 million additional Americans.

The agency estimates that the proposal would reduce the federal deficit by $130 billion over the next 10 years, through 2019. Any effect on the deficit in the following decade would be "subject to substantial uncertainty," but probably would result in "small reductions in federal budget deficits," according to budget office analysts.

A minimum of 60 votes is required to break a filibuster in the 100-member Senate. The outcome of the Senate vote was unclear before Saturday afternoon, when Sen. Blanche Lincoln, D-Arkansas, announced her intention to back a floor debate on the measure.

Lincoln, a key moderate probably facing a tough re-election campaign in 2010, said the issue deserved further debate and consideration. She made clear, however, that she opposes several aspects of Reid's bill, including a controversial government-run public option.

"Although I don't agree with everything in this bill, I believe it is important to begin debate," Lincoln said.

"The issue is very complex. There is no easy fix."

Republicans wasted no time tearing into Lincoln's vote, issuing a news release while she was still announcing her decision, proclaiming that she had caved to "pressure from the left wing of her party."