Washington - And then there was one.
Historic health care legislation advanced to a Saturday night Senate showdown as centrist Sen. Mary Landrieu, D-La., fell in line as the 59th vote in an early test of party unity on President Barack Obama's top domestic initiative.
"It is clear to me that doing nothing is not an option," Landrieu said on the Senate floor as she delivered her long-awaited announcement just hours before the 8 p.m. EST vote.
Senate Majority Leader Harry Reid, D-Nev., needs 60 votes in the 100-member Senate to go forward on his 2,074-page bill to overhaul the nation's health care system. The lone holdout is another moderate Democrat, Sen. Blanche Lincoln of Arkansas, who faces a tough re-election next year.
The Senate's 40 Republicans are unanimously opposed.
A largely overlooked provision in the Senate bill would send $100 million to Louisiana to help it cover costs for Medicaid, the federal-state health care program for the poor. In her speech, Landrieu rejected the notion that she was voting to advance the bill simply because of the money.
"I'm not going to be defensive about asking for help," she said, recalling the devastation inflicted on her state by Hurricane Katrina in 2005. "I'm proud to have asked for it."
During earlier debate on the bill, Democrats called a revamp of the nation's health care system long overdue.
"The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," Sen. Patrick Leahy, D-Vt., said during the rare weekend session.
United in opposition, Republicans cast the bill as a costly government takeover, built on budget gimmicks.
"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., referring to the mastermind of a multibillion-dollar Ponzi scheme.
Most everyone would be required to purchase insurance under Reid's legislation, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage to 30 million uninsured. Insurance companies would no longer be allowed to deny coverage to people with medical conditions or drop coverage when someone gets sick.
The action in the Senate comes two weeks after the House approved a health overhaul bill of its own on a 220-215 vote. After the vote Saturday night, senators will leave for a Thanksgiving recess. Upon their return, assuming Democrats prevail on the vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.
Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions before a final package could land on Obama's desk.
The bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.
Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.
Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.