The Medicare vote came down to the wire in dramatic fashion as 18 Republicans broke with their party to pass the House-backed bill.

Sighs of relief could be heard on the Democratic side as lawmakers, beginning with Sen. Kay Bailey Hutchison (R-Texas), chairwoman of the Republican Policy Committee, joined with Democrats to pass the bill by a 69-30 margin. Hutchison’s Texas colleague, Sen. John Cornyn (R), who was on the receiving end of an American Medical Association ad blitz slamming his pre-recess position, also ended up voting for the bill.

But the most dramatic moment came when Sen. Edward Kennedy (D-Mass.), who is undergoing treatment for a brain tumor, arrived to cast the critical vote. Democrats were one vote shy of achieving cloture before the recess, and as soon as it became clear that they had the votes this time, Republicans followed suit.

Other Republicans who voted to proceed to debate on the politically charged bill included Sens. Elizabeth Dole (N.C.), George Voinovich (Ohio), Susan Collins (Maine), Norm Coleman (Minn.), Pat Roberts (Kan.) Gordon Smith (Ore.), Lisa Murkowski (Alaska), Bob Corker (Tenn.), Johnny Isakson (Ga.), Arlen Specter (Pa.) and Mel Martinez (Fla.).

Throughout the day, the pressure was on several GOP lawmakers to side with Democrats on the measure. Vice President Cheney came early to the weekly Republican luncheon, where the Medicare vote was discussed.