The US Senate has voted to hold a full debate on a landmark bill designed to overhaul the country’s healthcare provision.
The move was passed 60 votes to 39, after Democrats earlier confirmed they had secured enough votes.
Two Democratic senators whose support had been in doubt said they would back the move, which was a key election pledge of President Barack Obama.
All but one of the 40 Republicans in the Senate voted against it.
Mr Obama has prioritised the reform, which is designed to secure coverage for millions of uninsured Americans.
Senate Democrat leader Harry Reid’s proposed $849bn (£508bn) bill would extend coverage to another 31 million people, or 94% of eligible citizens, he said on Friday.
The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives
Patrick Leahy
Vermont Democrat
The legislation, which was outlined in a 2,074-page document, is said by Democratic aides to reduce deficits by $127bn (£76bn) over a decade and by as much as $650bn (£389bn) in the 10 years after that.
But it has been criticised by Republicans as being too expensive. They say they will block it, and debate is expected to be fiery.
Anything less than 60 votes for the initial measure would have left the bill vulnerable to Republican delaying tactics.
Need for debate
Efforts to get it passed had focused on three centrist Democrats – Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana – who expressed doubts about the bill.
Senator Nelson backed the procedural vote on Friday, but Senators Lincoln and Landrieu only declared themselves hours before it was due to take place.
Senator Lincoln said that it was important to start debating the issue. All three continue to have deep reservations about the bill itself.
The House of Representatives narrowly passed its own version of the reforms earlier this month.
Medicare cuts
Mr Reid opened the session by presenting highlights of the plan.
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Patrick Leahy, a Democrat from Vermont, said it was vital to back the bill.
“The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives,” he said.
But Republican leader Mitch McConnell urged Senators to vote against “this staggering spending programme at a time when many would argue our international bankers, the Chinese, are lecturing us about debt”.
Under the bill, most Americans would have to have health insurance, while private insurers would be banned from refusing to provide insurance because applicants had pre-existing medical conditions.
Insurance would be made more affordable with subsidies available to help those in lower income bands, the Democrats say.
People would also be able to take part in new insurance market places and be able to choose to buy government-sold insurance from 2014, a provision intended to help regulate the prices charged by private companies.
Large companies would be required by law to provide coverage to staff. The costs would be covered by government cuts on future Medicare spending.
If the Senate eventually passes its bill, it must then be reconciled with the House of Representatives bill and voted on again before the programme can become law.
Mr Reid’s bill differs to the House bill in that he calls for an increase of a half percentage point in Medicare payroll tax for people with an income of over $200,000 (£119,779) per annum – rising to $250,000 (£149,724) for couples.
There is also a tax on high-value insurance policies that is not contained in the House version of the bill.
If approved, the legislation could lead to the biggest changes in American healthcare in decades.
