U.S. House passes health plan

WASHINGTON — Handing President Obama a hard-fought victory, the House narrowly approved an overhaul of the nation's health-care system late Saturday, advancing legislation the Democrats said could be their defining social-policy achievement.

If passed by the Senate, the bill would bring about the most sweeping changes in the nation's health-care system since Medicare was created 44 years ago.

After a daylong debate, lawmakers voted 220-215 to approve a plan that would cost $1.1 trillion over 10 years.

Supporters cheered and applauded as it became clear the measure had won, but the vote was excruciatingly close, just two more than 218 needed. One Republican, Rep. Anh Cao of Louisiana, voted for the bill, and 39 Democrats, including Washington state's Brian Baird, opposed it. GOP House leaders had predicted their members would unanimously oppose the bill.

Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry Reid, D-Nev., hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama's desk before the new year.

Two key votes preceded passage of the bill: one, 242-192, authorized the bill to be debated, a key test of Democratic strength; a second one banned government-subsidized health insurance from covering elective abortions. That vote was 240-194.

House Democrats hope to make changes to the abortion amendment during negotiations with the Senate.

Democrats said the health-care measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance and would create a government-health insurance program, a concept known as the "public option." It would end insurance company practices such as not covering pre-existing conditions or dropping people when they become ill.

The successful vote came after Obama traveled to Capitol Hill on Saturday morning to make a personal appeal for lawmakers to "answer the call of history" and support the bill.

The House also defeated the Republicans' more modest plan, whose authors said was a more common-sense and fiscally responsible approach. Rep. Timothy Johnson, R-Ill., was the only lawmaker to cross party lines on the 258-176 vote.

Of the Democratic bill, Rep. John Dingell, D-Mich., 83 — who has introduced national health insurance in every Congress since succeeding his father in 1955 — said, "It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it."

Some Democrats said they voted for the legislation so they could seek improvements in it. "This bill will get better in the Senate," said Rep. Jim Cooper, D-Tenn., who criticized some provisions of the bill but decided to support it. "If we kill it here, it won't have a chance to get better."

House approval moves the bill well beyond the health-care overhaul attempted by President Clinton in 1993.

Lawmakers credited Obama with converting a final few holdouts during his appearance at a closed-door meeting with Democrats just hours before the vote.

A handful of remaining undecided lawmakers swung behind the proposal.

Another turning point was the decision by Speaker Nancy Pelosi late Friday to allow anti-abortion Democrats to try to tighten restrictions on coverage for the procedure under any insurance plan that receives federal money. That concession eased a threat by some Democrats to abandon the bill but also left Democrats who support abortion rights facing a choice between backing a provision they bitterly opposed or scuttling the bill.

Obama acknowledged the political difficulty of supporting major legislation in the face of Republican opposition and tough criticism from conservatives.

But, those present at Saturday's meeting said, he urged them on, saying, "When I sign this in the Rose Garden, each and every one of you will be able to look back and say, 'This was my finest moment in politics.' "

Republicans said the measure was too costly and would end up burdening the nation for decades.

"This bill is a wrecking ball to the entire economy," said Rep. Jack Kingston, R-Ga. "We need targeted specific reforms to help people who have fallen through the health-care cracks."

The House legislation would for the first time require every individual to obtain insurance and would require all but the smallest employers to provide coverage to workers. It would vastly expand Medicaid and create a marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.

Though some people would receive no benefits — including about 6 million illegal immigrants, according to congressional estimates — the bill would virtually close the coverage gap for people who do not have access to health-care coverage through their jobs.

"For generations, the American people have called for affordable, quality health care for their families," House Speaker Nancy Pelosi, D-Calif., said before the vote. "Today, the call will be answered."

The debate on the House floor extended for about 12 hours and settled into a civil, if predictable, pattern after a heated start.

Republicans tried throughout the day to create doubt and delay, shouting objections to routine parliamentary requests.

The Republicans skipped out of the chamber in the middle of debate to join several hundred activists at a protest on the Capitol lawn. "My vote is not just no; I wish there was a place for 'Hell, no,' " Rep. Pete Sessions, R-Texas, told the crowd. Rep. Steve King, R-Iowa, led a chant of "Hell, no!"

Activists then wheeled a giant toilet-paper roll, made from a printout of the health-care bill, toward the Capitol steps.

Material from The Washington Post and The Associated Press is included in this report.