The Senate on December 24 gave its approval – on a 60-39 vote – to a health care reform bill, a historic move but one that does not include any of the pro-gay provisions adopted in the House version of the bill.

Now the push begins to craft a single bill in a conference committee.

Senate Majority Leader Harry Reid (D-Nevada) told reporters following the Christmas Eve vote that he did not want to view the vote as 60 Democrats (and independents) against 40 Republicans (one was missing but opposed the bill).

"I see it as 60 leaders who stood up to insurance companies and stood up for working families all across America," said Reid.

Whether those 60 leaders are willing to stand up to legislators hostile to equal rights for LGBT people is another question about which community leaders are uncertain.

Early expectations were that a House-Senate conference committee would begin meeting right away to hammer out a final version of the bill for both houses to then give final approval. And many senators began predicting the final version would look more like the Senate version than the House.

But the Democratic leadership could choose some means other than a conference committee for creating a final version, and some political observers believe House Speaker Nancy Pelosi (D-San Francisco) will put up at least some fight for House provisions.

While both bills are aimed at making health care insurance affordable for millions more Americans, there are a number of differences between the Senate and House bills. The House offers a government-funded insurance option – the so-called public option; the Senate bill does not. The House bill prohibits federal funds from being used to cover the cost of an abortion with any insurance plan; the Senate version provides a means by which people could pay for abortion coverage themselves, even if their insurance plan involves federal subsidies.

The House version, passed in early November, has at least four provisions that benefit gay people specifically:

- Eliminating the tax penalty to gay employees who provide coverage for their spouses or partners under their employers' health insurance policies;

- Calling on the Department of Health and Human Services to address "health disparities" suffered by populations, including those based on "sexual orientation and gender identity"

- Making people with HIV and low incomes eligible for federal assistance earlier in their illness; and

- Prohibiting discrimination based on "personal characteristics" in the delivery of health care.

The Senate version includes none of these. And the battles over the public option and abortion have threatened to completely derail the overall health care legislation at numerous points. They are expected to be contentious issues again in conference.

Jerilyn Goodman, a spokeswoman for openly gay Representative Tammy Baldwin (D-Wisconsin) who sponsored two of the four pro-gay provisions in the House bill, said Baldwin is "fully committed to a thorough conference of the health care reform legislation in which she can advocate for the LGBT provisions included in the House bill."

"She is opposed to a straight vote on the Senate bill without the opportunity to add a number of House-only provisions, including those benefiting the LGBT community," said Goodman.

The Human Rights Campaign's legislative director, Allison Herwitt, said the group is "disappointed that the Senate did not include any of the LGBT-specific provisions that we have been working to advance throughout the health reform debate."

While Herwitt said HRC would "continue to push the congressional leadership to ensure that critical protections for LGBT people are part of the final measure," she acknowledged that the conference negotiations "will undoubtedly be complex and difficult on a range of issues."

Michael Mitchell, the new executive director of the National Stonewall Democrats, said he's the "eternal optimist" and hopes the pro-LGBT provisions can be retained in the final bill.

Mitchell said Stonewall Democrats endorsed a "robust public option" and support the overall health care reform legislation as a way to help LGBT people. That, he said, is because most health care insurance systems are based on relationship status, making it more difficult for most LGBT people to get insurance in the first place. And those who are able to obtain insurance through their partner or spouse's employer's plan have to pay taxes on it.

Charles Moran, national spokesman for the Log Cabin Republicans, said his group is "firmly opposed" to the overall health care legislation as a matter of core Republican principle. But they do support the pro-gay provisions and are "worried those might get jettisoned" during the conference.

"First they dropped abortion," said Moran. "We're next."