Senate Democrats passed a landmark health care bill Thursday that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in US history.The 60-39 vote on a cold Christmas Eve morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point.Vice President Joe Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."The tally far exceeded the simple majority required for passage.The Senate's bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures, but Democrats say they've come too far now to fail.Both bills would extend health insurance to more than 30 million more Americans.Vicki Kennedy, the widow of the late Massachusetts Sen. Edward Kennedy, who made health reform his life's work, watched the vote from the gallery."This morning isn't the end of the process, it's merely the beginning. We'll continue to build on this success to improve our health system even more," Majority Leader Harry Reid said before the vote. "But that process cannot begin unless we start today ... there may not be a next time."The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties.Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, Minority Leader Mitch McConnell, a Republican from Kentucky, contended before the vote, "they wouldn't be rushing it through Congress on Christmas Eve."The occasion was moving for many who had followed Kennedy, who died in August."He's having a merry Christmas in Heaven," Sen. Paul Kirk, a Democrat who was appointed to fill Kennedy's seat in Massachusetts, told reporters after the tally.Kirk said he was "humbled to be here with the honor of casting essentially his vote."The Senate also voted to raise the ceiling on the government's debt to $12.4 billion.