The second vote was set for early Tuesday morning as 
exhausted but happy Democratic leaders pushed the landmark 
legislation toward passage before Christmas.
   The outcome of the vote to overcome GOP opposition to the 
2074 page legislation is preordained. Majority Leader Harry 
Reid, D-Nev, has herded 58 Democrats and two independents into 
line through a combination of wheedling, cajoling and 
dispensing special deals. The strategy has Republicans irate 
but Reid makes no apologies.
    I don't know if there's a senator that doesn't have 
something in this bill that was important to them, and if they 
don't have something in it important to them, then it doesn't 
speak well of them," Reid said Monday.
    Examples include $100 million to pay the full cost of a 
Medicaid expansion in Nebraska, home to Democratic Sen. 
Ben Nelson, the crucial 60th vote for the bill. Another 
concession, sought by Sen Bill Nelson, D-Fla, exempts roughly 
800,000 seniors in Florida from potential benefit cuts by 
private Medicare Advantage plans.
    The 10-year, nearly $1 trillion plan would extend coverage 
to some 30 million uninsured Americans, with a new requirement 
for almost everyone to purchase insurance. Subsidies would be 
provided to help lower-income people do so, and businesses would 
be encouraged to cover their employees through a combination of 
tax breaks and penalties.
    Unpopular insurance company practices such as denying coverage 
to people with existing health conditions would be banned. 
Uninsured or self-employed Americans would have a new way to 
buy health insurance, via marketplaces called exchanges where 
private insurers would sell health plans required to meet certain 
minimum standards. The legislation will make a "tremendous difference 
for families, for seniors, for businesses and for the country as a 
whole," Obama said Monday.
    The American Medical Association announced its endorsement after 
Reid made some last-minute changes to please the doctors. A 5 percent 
tax on elective cosmetic surgery procedures was replaced with a 10 
percent tax on indoor tanning services; a proposed fee on physicians 
to enroll in Medicare was dropped; and payment cuts to specialty and 
other physicians to pay for bonuses to primary care doctors in 
underserved areas were also eliminated, said the AMA's president-elect.