Republicans said the bill encourages more choice and competition to hold down costs. It includes subsidies for the chronically ill and those with pre-existing conditions, funded by a tax on premiums of up to $4 per person per month for nearly all Maine policyholders.

No one could be denied health insurance or kicked off a plan for getting sick or having pre-existing conditions. Starting in 2014, Mainers buying individual insurance, not through employers, could buy policies from companies based in New Hampshire, Massachusetts, Rhode Island and Connecticut.

Senate Majority Leader Jon Courtney, R-Springvale, agreed change is needed, saying, "The good intentions of the past have led us to some of the highest health insurance rates in the country."

Premiums paid by employers in Maine are comparable to the rest of New England, but higher than overall U.S. average, according to an April 2009 report to the Legislature by an advisory council of doctors, insurers and public health professionals.

The report also said Maine's per person medical spending was 24 percent higher than the U.S. average and second-highest in the country.

Fellow Republican Sen. Lois Snowe-Mello of Poland said Monday's vote marks "a day when we move further down the road to prosperity" by making insurance available and affordable to the roughly 130,000 Mainers, one-tenth of the state's population, who lack it.

A Democrat who supported the amended bill, Sen. Nancy Sullivan of Biddeford, expressed uncertainty over whether the bill would accomplish all that's promised.

"The burden of this bill being successful is on the other side of the aisle," said Sullivan. But she agreed that "we must move ahead," adding that other pressing issues such as the state budget await action with less than a month left in the session's schedule.

Other Democrats continued to voice concerns that the bill's financial implications have not been sufficiently studied. Sen. Philip Bartlett II, D-Gorham, also questioned a provision that he said allows state employees to avoid paying the $4 premium tax.

"We have been exempted. It's a significant problem," said Bartlett.

Democrats also questioned whether the legislation should pass while President Barack Obama's health care overhaul law is taking effect. Sullivan said most of the Maine bill is based on the federal law, and if the federal law winds up being struck down by the courts, "this bill will crumble."

LePage, a Republican, supports the newly enacted Maine bill, but it was not clear whether he would sign it Monday or later, spokeswoman Adrienne Bennett said.