Passage of a Senate health insurance reform bill was all but assured after Democrats and GOP moderates defeated a controversial provision to expand the use of medical savings accounts late last week.
Lawmakers voted 52 to 46 against adding the MSA measure to the legislation.
Senate Majority Leader Bob Dole (R-Kan.) predicted this week's vote on passage of the plan would be almost unanimous.
The final roll call was postponed because Sen. Connie Mack (R-Fla.) was absent from Capitol Hill after the death of his father.
Last week's defeat of a Dole-sponsored measure that would have given favorable tax treatment for MSAs came after intense efforts to garner support by Dole and the opponents of the measure. The latter included both of the broader bill's chief sponsors, Sens. Nancy Kassebaum (R-Kan.) and Edward Kennedy (D-Mass.).
At one point, the vote appeared so close that Vice President Al Gore was summoned to vote to kill the MSA measure if the Senate had been deadlocked in a tie. All 47 Democrats and five Republicans voted against the measure.
GOP supporters have touted MSAs as a free-market method of expanding healthcare coverage. They would be private accounts that individuals could use to pay for some of their medical care.
But Democrats, including some who previously have supported the accounts, contended that only the healthiest and wealthiest will choose to open MSAs, leaving only the poor and sick in the insurance pool.
Kennedy said he and other Democrats would filibuster the bill to death if it included an MSA provision.
"It is effectively a poison pill," Kennedy said of the MSA provision. "It's highly divisive, highly controversial and highly unacceptable."
But Dole said the issue is not dead and could be included in a House-Senate conference that will reconcile differences between the two bills.
The House-passed version of health insurance reform does include an MSA measure.
The Kennedy-Kassebaum bill, as originally written, would allow employees to carry their health insurance from one employer to another and would require insurers to offer an individual policy to workers who lose their employer-sponsored coverage.
It also requires insurers to sell policies to any employer with two or more employees. Nearly 60 senators of both parties have co-sponsored the bill.
It did not include many of the controversial provisions, such as tax incentives to encourage the use of MSAs and medical malpractice reform that were part of the health insurance plan passed by the House late last month.
Like the House plan, however, the Senate bill would increase the tax deductibility for self-employed people who buy their own health insurance and would make long-term-care expenses and insurance premiums tax-deductible.
The White House, which opposed MSAs, did not oppose those measures, according to a Clinton administration official.