Obama health care overhaul clears key hurdle

The chamber's 58 Democrats and two independent allies -- exactly the 60 senators needed -- voted to end debate on a hard-fought compromise bill, the first of a series of critical votes the legislation faces this week.

All 40 Republicans voted against the measure, but acknowledged that for the moment they lacked the power to kill the sweeping proposal, which was expected to pass by Obama's self-imposed Christmas deadline.

That would set the stage for tough negotiations in 2010 -- a mid-term election year -- as the Senate and House of Representatives try to reconcile their rival versions and send a final bill to Obama to sign into law before his State of the Union speech in January or early February.

The atmosphere was intensely partisan, but the outcome preordained as senators cast their votes from their desks, a practice reserved for issues of particular importance. Administration officials who have worked intensely on the issue watched from the visitor's gallery despite the hour.

So, too, did Vicki Kennedy, the widow of Democratic Senator Edward M Kennedy, who championed health care across a Senate career that spanned more than 40 years.

Democratic Senator Ben Nelson's announcement Saturday that he had decided to support the bill - in exchange for a variety of concessions - cemented the Democrats' 60-vote majority behind a bill assembled at the direction of Majority Leader Harry Reid.

Among the top likely intra-party Democratic feuds: Tough new restrictions on federal monies going to subsidise abortions and the Senate's decision to strip out a government-backed "public option" to compete with private insurers.

The highly unusual vote at 1am (1700 AEDT) came after a day of often bitter debate inside the Capitol as Washington dug out from under its worst winter storm in years, which dumped a thick layer of snow and iced-over some roads. "What the American people ought to pray is that somebody can't make the vote tonight.

That's what they ought to pray," said Republican Senator Tom Coburn, a medical doctor. That drew a sharp rebuke from Senator Dick Durbin, the number two Democrat, who said he did not "think it's appropriate to be invoking prayer to wish misfortune on a colleague".

"We are becoming more coarse and more divided here," he scolded. "I don't wish misfortune on any of my colleagues."

The underlying legislation, which faces a likely Christmas Eve vote on Thursday, would extend coverage to 31 million of the 36 million Americans who currently lack insurance. It would require most Americans to buy insurance and offer subsidies for low-income families to do so, while forbidding insurers from denying coverage because of pre-existing medical conditions.

Democrats said the bill met Obama's goals of costing less than $US900 billion ($A1.01 trillion) and not add to the deficit, citing findings from the non-partisan Congressional Budget Office that it will cost $US871 billion ($A977.66 billion) over the next 10 years and cut the deficit by about $US132 billion ($A148.16 billion).

The United States is the world's richest nation but the only industrialised democracy that does not provide health care coverage to all of its citizens.

Washington spends more than double what Britain, France and Germany do per person on health care, but lags behind other countries in life expectancy and infant mortality, according to the Organisation for Economic Co-operation and Development (OECD).