House Democrats give final passage to historic health care overhaul

WASHINGTON — Ending Democrats' decades-long quest to create a health care safety net to match Social Security, the House of Representatives Sunday approved sweeping legislation to guarantee Americans access to medical care for the first time in history and delivered President Barack Obama the biggest victory of his young presidency.

The bill, which passed 219-212 without a single Republican vote, will make a nearly $1 trillion commitment in taxpayer money over the next decade to help an estimated 32 million uninsured Americans get health coverage.

And it will establish a broad new framework of government regulation to prevent insurance companies from denying coverage and, advocates hope, to begin making healthcare more affordable.

"Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics. ... We proved we are still a people capable of doing big things and tackling our biggest challenges," the president said in a televised address from the East Room of the White House after the House completed its last vote.

On the House floor, Democrats erupted into cheers of "Yes, we can!" at 10:45 p.m. eastern time as the decisive 216th "yes" vote was recorded, capping a tortuous campaign that several senior lawmakers linked to the historic battle for civil rights two generations earlier.

"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.

Obama is to sign the bill within the next few days, while the Senate plans this week to begin debating a package of changes to the health care legislation that the House also passed Sunday 220-211.

The House roll calls came at the end of a balmy spring weekend that followed an unusually harsh Washington winter. But it brought no political thaw to Capitol Hill.

Angry protesters swarmed over the Capitol lawn throughout the day, cheering sympathetic Republicans who urged them on from the House balcony. They called for lawmakers to "Kill the Bill" and warned of dire political consequences for Democrats who voted for the legislation. "We will remember in November," the crowd chanted.

Thirty-four Democrats, most from Republican leaning districts, voted against the main legislation approving the blueprint for health care.

Rep. Pete Sessions, R-Texas, chairman of the National Republican Congressional Committee, promised that GOP candidates would turn the 2010 midterm elections into a referendum on health care. "We will run on a promise of repeal," he said.

Many Republicans say the overhaul will drive the nation deeper into a debt at a time when it is still struggling to recover from recession. "We can't even afford the government we've got right now, and we're going to be putting this new ... entitlement on top of it," Rep. Paul Ryan, R-Wis., warned on the House floor.

But after a final flurry of negotiating diffused an intraparty dispute over abortion and locked down the last votes, Democratic lawmakers, some of whom have spent decades in Congress pushing for universal health coverage, were celebrating the pay-off of a monumental gamble.

Obama and his congressional allies succeeded in pushing through the most sweeping piece of social legislation since the 1965 Medicare bill, despite a crippling recession and an increasingly angry electorate.

Democrats — and the country — now face an uncertain future as the legislation is implemented over the next decade and the government begins to play a larger oversight role in matters that touch powerful industries and personal lives.

Many of the overhaul provisions will not take effect for years. And even some supporters of the mind-numbingly complex package acknowledge there is no guarantee it alone can restrain the skyrocketing cost of health care.

More immediately, Democrats must steer a package of fixes to the health care bill through the Senate by using the arcane budget reconciliation process.

The maneuver allows Senate Democrats to skirt a GOP filibuster and pass the package with only 51 votes rather than 60. But if Republicans succeed in making any changes to the package on the Senate floor — as Democratic officials acknowledge is possible — the House would have to take another health care vote.

But Sunday, after more than a year of procedural delays, electoral set-backs, partisan battling — and yet another nail-biting search for votes — congressional Democrats seemed more focused more on history than the remaining parliamentary obstacles.

Meeting at midday behind closed doors across the street from the Capitol, they received a final pep talk from Rep. John Lewis, D-Ga., a veteran of the Civil Rights movement who the day before had been the target of racial epithets from a crowd of protesters.

Lewis reminded the assembled lawmakers Sunday that they were voting on the 45th anniversary of one of the famous Civil Rights marches between Selma and Montgomery, Ala., Lewis had been beaten by police during the first of those marches.

After the caucus meeting ended, Lewis linked arms with Pelosi and other senior Democrats for a walk with the assembled lawmakers to the Capitol through a gauntlet of angry protesters who denounced them, shouting "Drop Dead Pelosi" and "Save the Constitution."

"We're locking arms behind a man who led a nation across a bridge ... 45 year ago," Pelosi said. " And today, he's going to lead us across this street and to vote for health care for the American people."

Pelosi carried with her an oversized wooden gavel given to her by Rep. John Dingell, D-Mich., the longest serving House member in history, who has introduced a universal coverage bill every Congress since 1955.

By late afternoon, Democrats cleared away the final obstacle as the White House struck a deal with a group of anti-abortion Democrats led by Rep. Bart Stupak, D-Mich.,who had withheld their support over concerns that the legislation did not sufficiently ensure that federal funding would not be used for abortion.

Under the terms of the agreement, the president agreed to issue an executive order directing his administration to develop guidelines to prohibit the use of taxpayer subsidies to pay for abortion services.

The order also reinforces restrictions barring community health centers from using federal funds for abortion services. The healthcare bill already requires women who buy federally subsidized insurance plans that cover abortion services to send their insurer a separate check to cover the abortion benefit.

The executive order drew immediate fire from several anti-abortion groups, who call it inadequate. "Executive orders can be undone or modified as quickly as they are created," warned Charmaine Yoest, president of Americans United for Life.

But Stupak, flanked by other socially conservative Democrats, said he was satisfied Sunday with the protections. "We've all stood on principle," he said.

Later on the House floor, Stupak chided GOP lawmakers for trying to scuttle the legislation with a procedural motion build on his abortion compromise. As Stupak was speaking, someone on the Republican section of chamber yelled "Baby Killer."

Several leading religious groups, including the heads of national orders of Catholic sisters, had already endorsed the Senate health care bill's restrictions on federal funding of abortion services.

The debate over abortion in recent days almost overshadowed the broad reach of the health care legislation that Democrats labored to assemble over the last year.

Party leaders designed their health care overhaul to preserve the employer-based health care system in which most Americans get insurance through work.

But the legislation would also dramatically expand federal regulation of health care. Federal law would for the first time require insurance companies to cover all Americans, regardless of their health status, and would prohibit insurers from denying coverage to people who become sick.

Individuals would also be required to buy insurance. And large employers would have to provide their employees with health benefits or in some cases face penalties.

The bill would open the nation's 45-year-old Medicaid insurance program for the poor to all Americans making less than 133 percent of the federal poverty line — $14,404 for an individual or $29,327 for a family of four.

The government would also create new state-based insurance marketplaces for millions of Americans who do not get coverage through work.

Commercial insurers would offer plans in these marketplaces, or exchanges, and be required to provide a minimum set of benefits, including mental health services, maternity care and preventive care.

The most expensive feature is a commitment by the federal government to provide nearly $500 billion in subsidies over the next decade to help millions of low- and moderate-income Americans buy insurance in an exchange.

The bill is also designed to give relief to small businesses, providing about $40 billion in tax subsidies to help them offset the cost of offering their employees health benefits.

And the legislation would make prescriptions more affordable for seniors by gradually closing the Medicare drug coverage gap, known as the "doughnut hole" over the next decade.

The major expansion in federal assistance to tens of millions of Americans is not without a cost.

To pay for their legislation, Democrats approved a new 3.8 percent tax on investment income for individuals making more than $200,000 and couples making more than $250,000. In 2008, people with high-end "Cadillac" health plans will be subject to a new tax on their benefits.

And Medical device makers, pharmaceutical companies and insurers will be subject to new excise taxes.

The bill would also cut more than $400 billion over the next decade in what Medicare pays to hospitals, nursing homes and insurance companies that provide Medicare Advantage plans, a provision that proponents hope will ultimately help make the system more efficient.

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