The Senate will begin debate Dec. 1 on its merged health reform bill, the "Patient Protection and Affordable Care Act" (H.R. 3590), after voting 60-39 Saturday to advance the bill. One Republican, Sen. George Voinovich (R-OH), was absent for the procedural vote, which passed along party lines. Senate debate and amendments to the bill could take several weeks. The final bill then must be merged with the House-approved health reform bill (H.R. 3962). The Congressional Budget Office estimates that the current Senate bill will cost $848 billion over 10 years and extend health coverage to 94% of legal U.S. residents by 2019, partly through a public insurance option from which states could opt out. By 2019, 24 million people would be left without coverage. The bill reduces hospital Medicare and Medicaid payments by roughly $106 billion by reducing market basket updates by 0.25% in 2010 and 2011 for inpatient and outpatient hospitals, inpatient psychiatric hospitals, inpatient rehabilitation facilities and long-term care hospitals. For 2012 through 2019, market basket updates would be reduced by an annual productivity adjustment plus an additional reduction of 0.2%.