The bill, which passed 219-212 without a single Republican vote, will make a nearly
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
On the House floor, Democrats erupted into cheers of "Yes, we can!" at
"This is the civil rights act of the 21st century," added Rep.
Obama is to sign the bill within the next few days, while the
The House roll calls came at the end of a balmy spring weekend that followed an unusually harsh
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.
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.
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
Obama and his congressional allies succeeded in pushing through the most sweeping piece of social legislation since the 1965
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
The maneuver allows Senate Democrats to skirt a
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.
Lewis reminded the assembled lawmakers Sunday that
they were voting on the 45th anniversary of one of the famous Civil
Rights marches between
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.
By late afternoon, Democrats cleared away the final obstacle as the
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
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
Several leading religious groups, including the heads of national orders of Catholic sisters, had already endorsed the
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
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
The bill is also designed to give relief to small businesses, providing about
And the legislation would make prescriptions more affordable for seniors by gradually closing the
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
And Medical device makers, pharmaceutical companies and insurers will be subject to new excise taxes.
The bill would also cut more than
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