<P> After the Finance Committee vote on October 15, negotiations turned to moderate Democrats . Majority leader Harry Reid focused on satisfying centrists . The holdouts came down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and conservative Nebraska Democrat Ben Nelson . Lieberman's demand that the bill not include a public option was met, although supporters won various concessions, including allowing state - based public options such as Vermont's Green Mountain Care . </P> <P> The White House and Reid addressed Nelson's concerns during a 13 - hour negotiation with two concessions: a compromise on abortion, modifying the language of the bill "to give states the right to prohibit coverage of abortion within their own insurance exchanges", which would require consumers to pay for the procedure out of pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska . The latter half of the compromise was derisively termed the "Cornhusker Kickback" and was repealed in the subsequent reconciliation amendment bill . </P> <P> On December 23, the Senate voted 60--39 to end debate on the bill: a cloture vote to end the filibuster . The bill then passed, also 60--39, on December 24, 2009, with all Democrats and two independents voting for it, and all Republicans against (except Jim Bunning, who did not vote). The bill was endorsed by the AMA and AARP . </P> <P> On January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain Republican filibusters . His victory had become significant because of its effects on the legislative process . The first was psychological: the symbolic importance of losing Kennedy's traditionally Democratic Massachusetts seat made many Congressional Democrats concerned about the political cost of passing a bill . </P>

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