After years of false starts, the Senate on Tuesday agreed to take up a bill that would allow small businesses to band together in purchasing health insurance.
A motion to begin a 30-hour debate on the bill, which has divided lawmakers, insurers, and trade groups, passed 96 to 2.
Despite nearly universal consensus on whether to hold the debate, Senate Democrats are widely expected to give the bill a rough ride.
"I believe the Senate will conclude that the course laid out in this proposal is the wrong one for health care," Sen. Edward Kennedy (D-Mass), said in a statement ahead of the debate.
The bill, introduced by Sen. Mike Enzi (R-Wyo.) and sponsored by Sens. Ben Nelson (D-Neb.) and Conrad Burns (R-Mont.), would pave the way for small-business health plans -- also known as association health plans, or AHPs. President Bush has touted the initiative as a way of curbing rising employer health-care costs.
Supporters say the plans allow small businesses to spread risk over a larger pool of employees by banding together through trade organizations across state lines, drawing the same discounts as larger companies.
Under the Bush administration, the House has passed four bills allowing AHPs, all of which failed to pass the Senate.
On Tuesday, Enzi called the motion to proceed a "major step toward providing more affordable health insurance options for small business and working families."
However, opponents say the move will usher in workplace health plans that don't cover sick employees.
The AARP, a national lobby group for seniors, has said AHPs allow health insurers to bypass state consumer protections, including fair prices for older workers.
Bill Novelli, who heads the group, said in a statement last month the Senate bill would give small businesses an "incentive to avoid hiring or retaining sicker or older workers."
Other high-profile opponents include the American Cancer Society Cancer Action Network and the American Diabetes Association.
A final vote is expected by the end of the week.