Republicans identified parliamentary problems with at least two provisions that will require the measure to be sent back to the House for yet another vote if it is adopted by the Senate. Some changes need to be incorporated in the Democrats' sweeping health care legislation for which the Senate has been working all night.

Senate Democrats want to defeat whatever amendments the Republicans propose for the bill.

Senator David Vitter, Republican of Louisiana, urging adoption of an amendment to exempt mobile mammography units from paying a federal fuel tax, suggested that a parliamentary issue has been found by his party that would force Democrats to send the package of changes to their health care legislation back to the House for one more vote.

Vitter said, "This reconciliation bill is already going back to the House."

However, every attempt is being made by Senate Democrats to avoid any changes in the bill so that they could approve the bill and send it to President Obama for his signature.

If a parliamentary ruling is passed in favor of the Republicans then an important provision in the bill could be knocked out. But for this another House vote will be needed.