The full extent of Reid's maneuvering was still unclear.

Nelson won numerous changes, including tougher restrictions on abortion coverage and an estimated $45 million in federal Medicaid funds, enough to completely cover his state's costs of complying with an expansion of the program mandated by the bill.

Vermont and Massachusetts also won additional Medicaid funds; plastic surgeons were persuasive in their bid to strip out a proposed tax on elective plastic surgery; hospitals in the Dakotas, Wyoming and Montana won additional Medicare funds; and there was more money for hospitals in Hawaii to treat the uninsured.

While Nelson's vote was the decisive one to fall into place for the Democrats, only an unpredictable series of events has left them with the ability to gain 60 without any help from Republicans.

They began the year with a caucus of 58, including 56 Democrats and two independents. Pennsylvania Sen. Arlen Specter added to their ranks in April when he suddenly bolted from the Republican party, and Sen. Al Franken made it 60 when he was sworn into office in July after a long Minnesota recount.

It was only a few weeks before Massachusetts Sen. Edward M. Kennedy, a longtime advocate of universal health care, succumbed after a long battle with brain cancer and Democrats reverted to 59 seats.

With a heavy push from Reid and the White House, and a request Kennedy wrote not long before his death, Democrats in the Massachusetts Legislature quickly changed state law so Gov. Deval Patrick could appoint a temporary replacement.

Paul Kirk, a longtime Kennedy associate and former chairman of the Democratic National Committee, was sworn in Sept. 25. "We're prepared to go to work," he said.

Doesn't seem like true support for the bill at all does it?