On Saturday, November 21st, the United States Senate, by a vote of 60 - 39, approved a cloture motion on the motion to proceed to consideration of H.R. 3590, the Patient Protection and Affordable Care Act.  This vote, while very important, only allows the Senate to move to consideration of the bill (i.e. begin debate and offer amendments).  This legislation represents a melding of two bills approved by the Senate Finance Committee and Senate Health Education Labor and Pensions Committee earlier this year.  The bill is more than 2,000 pages long and incorporates provisions from both committee bills, as well as proposals that were never considered by either Committee.  This is permissible under the rules of the Senate because technically, the "Patient Protection and Affordable Care Act" is an amendment to a bill previously approved by the House.