The Senate passed an $18 billion bill on Thursday to restore unemployment benefits for people who have been out of a job for months and resume Medicare payments to doctors about to absorb a 21 percent cut.

The 59-38 vote sends the measure back to the House, which was expected to vote and send it for President Barack Obama's signature Thursday night.

The vote comes as welcome relief to hundreds of thousands of people who have been ineligible to reapply for additional weeks of benefits after exhausting their state-paid benefits. They will be able to receive those checks retroactively under the legislation.

Several other popular programs had also expired, including federal flood insurance, higher Medicare payment rates for doctors and generous health insurance subsidies for people who have lost their jobs.

The situation became more urgent Thursday afternoon when Medicare announced that it would start paying doctors' claims at a 21 percent lower rate. That won't be necessary now.

Thursday's measure provides unemployment checks averaging $335 a week to people whose 26 weeks of state-paid benefits have run out. It's a temporary extension through June 2 that gives House and Senate Democrats time to iron out a measure to fund the program through the end of the year.

The bill also extends a program created under last year's economic stimulus bill that gives unemployed people a 65 percent subsidy on health care premiums under the so-called COBRA program.

On successive votes earlier in the day, Democrats narrowly turned back two amendments by Sen. Tom Coburn, R-Okla., that would have paid for the measure over time by cutting spending and raising almost $10 billion in revenues with a variety of Democratic-backed ideas to tighten the tax code. One of Coburn's amendments was killed by a 50-48 vote.

The topic of providing additional weeks of jobless benefits in the midst of bad times had been regarded as routine. But with conservative voters and tea party activists up in arms about the deficit, conservative Senate Republicans upset about the deficit have twice caused interruptions of jobless benefits and other programs.

In February, it was Jim Bunning, R-Ky., who single-handedly blocked an extension of unemployment benefits in an unsuccessful bid to force Democrats to pay for them. The measure passed on a 78-19 vote after Republicans were smacked by a public relations backlash.

But many Republicans believe it was a stand worth taking, including Coburn, who blocked a vote last month on another short-term extension.

By the time Senators returned from a two-week recess on Monday, only four Republicans — Susan Collins and Olympia Snowe of Maine, Scott Brown of Massachusetts and George Voinovich of Ohio — voted with Democrats to defeat a GOP filibuster of the bill. Only Voinovich, Collins and Snowe voted for the bill on Thursday.

Twenty-one Republicans voted for the earlier extension last month. But Thursday's vote came after senators spent two weeks among their constituents — and as thousands of tea party activists came to Washington to protest on deadline day for filing taxes.

"I think people spent two weeks out listening to people about spending and debt," Coburn said.

The House has twice this year approved short-term extensions of jobless benefits and other expired programs.

The various programs in the longer-term legislation represent much of the Democrats' remaining agenda on job creation. One of the reasons the short-term legislation was needed is that House and Senate Democrats are having difficulty resolving their differences on how to pay for a package of expired tax breaks for individuals and businesses.

Other elements of the jobs agenda such as cash to build roads and schools and help local governments keep teachers on the payroll, remain on the shelf for a lack of money to pay for them.

Democrats said deficit-financed jobless benefits not only needed to help people unable to find work but that they are one of the most effective ways to pump up the still-struggling economy.

"Apparently, the Democrats don't feel it's that important to help those families in need unless they can also add to our nation's out-of-control deficit," Bunning said.