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Both supporters and opponents called the vote one of the most significant in recent Senate history. Sen. Tom Harkin, Iowa Democrat and chairman of the Health, Education, Labor and Pensions Committee, called the vote a “pivotal point in the decades-long request to pass comprehensive health care reform.”

Republicans in turn united in opposition to the final bill over concerns that it would raise taxes and insurance premiums, cut Medicare funding and put the government between doctors and patients. They had hoped to block or stall the vote, but ran out of procedural options in the closing days.

“History in our future generations will judge us on this vote,” warned Sen. Orrin G. Hatch, Utah Republican, on the Senate floor.

He labeled the vote as one “that will fundamentally change the American landscape for generations to come and restructure one-sixth of our American economy. … Make no mistake, our actions on this vote will not be without consequences.”

Backers say the legislation will extend coverage to 31 million new Americans, curb insurance company abuses, give low- and middle-income Americans tax credits to help them buy coverage and establish an independent board to keep Medicare solvent.

In the search for compromise to reach 60 votes, the bill doesn’t have either the public insurance plan or the alternative Medicare expansion for which many liberal Democrats had been hoping.

The votes are being held at odd times — from the middle of the night to just after dawn — because Senate rules require at least one calendar day and an hour between the time the so-called “cloture” vote is requested and when it is held. Democrats could have postponed the votes until normal business hours, but that would have pushed the final vote for passage to Christmas Day.