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The acrimonious health care debate entered its final chapter Thursday with Senate passage of a bill that would reshape the health insurance market and extend coverage to an estimated 31 million people.

If enacted after upcoming negotiations with the House, the Senate bill would prompt a near total overhaul of the American health care system — changing how medical services are financed, regulated and measured for quality.

After well over a year of planning, markups, closed-door negotiations and floor action, the 60-39 party-line vote advanced what could become the largest expansion of the governments role in social policy since Lyndon B. Johnsons Great Society programs.

President Obama, who delayed his holiday trip to Hawaii to await the Senate vote, hailed passage of the bill.

Vice President Joseph R. Biden Jr. was in the chair and the galleries were packed as senators cast their votes from their seats, following final remarks by Majority Leader Harry Reid, D-Nev., and Mitch McConnell, R-Ky. Jim Bunning, R-Ky., was the lone absentee.

The majoritys victory was tempered by the prospect of contentious negotiations with the House over abortion and revenue provisions in particular. The House passed its own health care overhaul on Nov. 7.

“Having passed reform bills in both the House and the Senate, we now have to take up the last and most important step and reach an agreement on a final reform bill that I can sign into law,” Obama said. “And I look forward to working with members of Congress in both chambers over the coming weeks to do exactly that.”

Starting in 2014, individuals would be required to have insurance or pay a penalty. And companies with more than 50 workers would be required to help provide affordable coverage or pay a fine. The expansion of coverage would be paid for with cuts in Medicare payments to providers, an excise tax on high-cost private health insurance plans, and an increase in the Medicare payroll tax for wealthy wage earners.

The legislation would expand health insurance coverage to more than 30 million uninsured Americans, according to the Congressional Budget Offices assessment. It would expand Medicaid — the federal-state health care entitlement for the poor — to everyone with incomes at or below 133 percent of the poverty level. It also would set up exchanges, or marketplaces, in all 50 states where insurance companies could compete for customers among individuals and small businesses that currently lack coverage. And it would establish a system of national, private insurance plans supervised by the Office of Personnel Management, the agency that administers federal employee health benefits, to be offered on the exchanges.

Senators voted from their desks, as they did during a key procedural vote early the morning of Dec. 21 that limited debate on the measure and proved they could overcome Republican filibusters. Biden, acting in his constitutional role as president of the Senate, presided — and was warmly greeted by his former colleagues.

The 7 a.m. vote came after Senate Democrats and Republicans agreed Wednesday to move up the roll call by an hour to give senators a little more time to travel home for Christmas. .

The Democrats prevailed over vigorous Republican opposition. “This debate has been dominated by partisanship and politics,” Reid said.

The roll call marked the first time the Senate has voted on Christmas Eve since 1895. It also fulfilled Reids goal of passing a health care bill by Christmas, with an eye toward sending a conference agreement to Obama for his signature in late January.

“This fight isnt over. My colleagues and I will work to stop this bill from becoming law, McConnell said.

McConnell was defiant. “I guarantee you the people who voted for this bill are going to get an earful when they finally get home for the first time since Thanksgiving,” said. “They know there is widespread opposition to this monstrosity.

“This is just the beginning,” Reid vowed. “With Sen. Ted Kennedys voice booming in our ears, with his passion in our hearts, we say as he said, The work goes on, the cause endures.”

Reid chided Republicans for framing the contest in political terms. He portrayed the legislation as a long overdue step toward universal coverage that will make health care more affordable and more accessible to millions of Americans.

The only GOP senator to vote for a health care overhaul bill at any step of the lengthy process was Olympia J. Snowe of Maine, who supported the Finance Committees version of the legislation last summer. But she refused to vote for the final version Thursday.

Reid was only one of many Democrats to invoke Kennedys name and pay tribute to his career-long drive for universal health coverage. The Massachusetts Democrat, stricken with a brain tumor in May 2008, died Aug. 25 before he could see his dream realized.

“Theres a kind of bittersweet quality to it,” Lieberman added. “because a reform of this size shouldnt happen along partisan lines.”

Joseph I. Lieberman, I-Conn., said he spoke to Snowe to wish her a good holiday, but also to express his regret that she was not able to vote for the bill. “My feeling to her was disappointment that we couldnt come to a point where there was some Republican support,” he said.

House and Senate aides have started their informal conference planning meetings, as have top Democrats in both chambers. Reid declined to discuss the upcoming talks. “Im not going to talk about conference,” the visibly fatigued leader said the night before the vote on final passage. “For a few days after that, Im going to watch my rabbits eat my cactus.”

“We held out our hand, but we were rebuffed,” said Tom Harkin, D-Iowa, chairman of the Senate Health, Education, Labor and Pensions Committee.