At the White House, Obama said his congressional allies were “on the precipice” of a historic accomplishment that has eluded presidents and lawmakers for generations, adding that the emerging bill included “all the criteria that I laid out” in a speech to a joint session of Congress earlier in the year.

“It is deficit-neutral,” he said. “It bends the cost curve. It covers 30 million Americans who don’t have health insurance, and it has extraordinary insurance reforms in there to make sure that we’re preventing abuse.”

In the privacy of a presidential meeting, liberal supporters of the bill vented their frustration at having to abandon the last vestige of a government-run insurance option in the legislation, a slow-motion concession made over many months, most recently to moderates including Sen. Joe Lieberman (I., Conn.).

Two days after jolting the leadership by threatening to oppose the measure if it included an expansion of Medicare, Lieberman said that with the agreed-upon changes, “I’m going to be in a position where I can say what I’ve wanted to say all along, that I’m ready to vote for health-care reform.”

That left Nelson, the only known holdout among the 60 senators who are members of the party’s caucus, a group that includes 58 Democrats, Lieberman, and Sen. Bernie Sanders (I., Vt.).

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