The full Senate began debate and consideration of amendments on the Patient Protection and Affordable Care Act on November 30.  Voting on amendments began on December 3.  The Senate legislation consolidates provisions that were approved by the Senate Finance Committee on October 13 with many provisions completed by the Senate Health, Education, Labor, and Pensions Committee on June 9, including grants to expand school-based health centers and a new, voluntary long term care insurance program offering cash benefits for consumer-directed assistance and supports.  The Senate legislation still contains several provisions, such as the much debated "public option" for consumers, which could delay a cloture vote indefinitely, and over a hundred other provisions which may be hard to reconcile with the very different bill that narrowly passed the House, 220-215, on November 7.  Both the Senate and House bills call for new federal rule-making and oversight, but the enforcement of health insurance market reforms and the operation of health insurance exchanges, to assure coverage for low-income persons and persons with pre-existing conditions would depend much more on states than federal agencies under the Senate bill.  State-operated exchanges, a cornerstone of the Senate bill, will be responsible for certifying health insurance plans, offering information to consumers on health insurance choices through web portals, processing applications for premium subsidies and tax credits using sliding scales related to consumers' incomes, and enrolling individuals in the private or public plan chosen by the consumer.