US Congress passes historic health care bill

The stakes could not have been higher for Obama. Opposition Republicans hoped that by blocking the legislation, they would be able to thwart the president's ambitious domestic agenda, including immigration reform and climate change legislation.

The health care issue is likely to shape the November congressional election, when Republicans try to capture control of both chambers. Democrats will campaign on having overhauled a system that has made both health care and insurance unaffordable for tens of millions of Americans. 

Republicans will say Democrats pushed through a bill that had little public support and will ultimately increase taxes and damage the quality of health care.

Widely viewed as dead two months ago, the Senate-passed bill cleared the House on Sunday night on a 219-212 vote, with Republicans unanimous in opposition.

“I want to thank every member of Congress who stood up tonight with courage and conviction to make health care reform a reality,” Obama said. “I know this wasn’t an easy vote for a lot of people. But it was the right vote.” Congressional officials said they expected Obama to sign the bill as early as Tuesday.

Obama watched the vote in the White House’s Roosevelt Room with Vice President Joe Biden and about 40 staff aides. When the long sought 216th vote came in -- the magic number needed for passage -- the room burst into applause and hugs. An exultant president exchanged a high-five with his chief of staff, Rahm Emanuel.

While national health care has been a goal of presidents stretching back decades, it has proved elusive, in part because self-reliance and suspicion of a strong central government remain strong in the America. After more than a year of political combat -- certain to persist into the election campaign for control of Congress -- debate on the House floor fell along predictable lines.

“We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans,” said Speaker Nancy Pelosi before the vote, referring the government’s pension program and health insurance for the elderly established nearly 50 years ago. “This is the civil rights act of the 21st century,” added Rep. Jim Clyburn, the top-ranking black member of the House.

Earlier in the day, the House argued its way through a thicket of Republican objections toward an evening vote on the bill to extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade.

Obama lobbied by phone from the White House, then took the crucial step of issuing an executive order that satisfied a small group of Democrats who demanded that no federal funds be used for elective abortions.

Over and over, Democrats stressed the historic nature of the day. The measure represents the biggest expansion of the social safety net since Medicare and Medicaid were enacted in 1965 during President Lyndon B. Johnson’s administration to provide government-funded health care coverage to the elderly and poor.

The 44th president’s quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election to fill Edward Kennedy’s Massachusetts Senate seat, and with it, enough votes to prevent a final vote.

But the White House, Pelosi and Senate Majority Leader Reid soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both chambers pass a fix-it measure incorporating numerous changes.

That smaller measure making the fixes cleared the House shortly before midnight and was sent to the Senate, where Democratic leaders said they had the votes necessary to pass it quickly. The vote was 220-211.

Under the legislation, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.

The insurance industry would come under new federal regulation. They would be forbidden from placing lifetime dollar limits on policies, from denying coverage because of pre-existing conditions and from canceling policies when a policyholder becomes ill.

Parents would be able to keep older children on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.

To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000.