WASHINGTON (AP) - President Barack Obama has scored the biggest victory of his presidency as Congress approved his signature health care reform bill, bringing near-universal coverage to a wealthy country in which tens of millions of people are uninsured.
The measure passed by the House of Representatives Sunday night represents the biggest expansion of the U.S. federal government's social safety net since Medicare and Medicaid were enacted in the 1960s during President Lyndon B. Johnson's administration to provide government-funded health care coverage to the elderly and poor.
Although the bill does not provide universal health care, it should expand coverage to about 95 percent of eligible Americans, compared with 83 percent today.
The health reform measure extends coverage to 32 million of the nearly 50 million people in the U.S. who lack it and bans insurers from denying coverage on the basis of pre-existing medical conditions. It would also usher in a significant expansion of Medicaid, the program for the poor.
Parents would be able to keep 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.
Under the legislation, most Americans would be required to purchase insurance, and face penalties if they refused. Once enacted, the measure would create a series of so-called "insurance exchanges" beginning in 2014 where self-employed people and small businesses could pool together to shop for health care coverage.
The stakes could not have been higher for Obama, who has pushed health care as his top priority since taking office in January 2009. The issue was seen as pivotal to other issues on the president's ambitious domestic agenda, including immigration reform and climate change legislation.
"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."
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 many. Republicans say the bill will ultimately increase taxes and damage the quality of health care and has little public support.
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.
A second, smaller measure - making changes in the first - 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.
Congressional officials said they expect Obama to sign the main bill as early as Tuesday.
Obama will travel outside Washington on Thursday as he now turns to seeing the companion bill through the Senate and selling the health care overhaul's benefits on behalf of House lawmakers who cast risky votes.
The president watched the House vote Sunday from the White House 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.
Republican Senator John McCain said Monday morning that Democrats have not heard the last of the health care debate, and said he was repulsed by "all this euphoria going on."
The Associated Press
McCain, who was Obama's rival in the 2008 presidential election, told ABC television that "outside the (Washington) Beltway, the American people are very angry. They don't like it, and we're going to repeal this."
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 America.
After more than a year of political combat, debate on the House floor fell along predictable lines. Not one Republican voted for the bill. Some moderate Democrats also voted against it.
Most Americans receive private health insurance through their jobs as part of their benefits, but employers are not required to offer coverage. The government covers the elderly and indigent.
Republicans readily agreed the bill would affect everyone in America - it will have an impact on one-sixth of the U.S. economy - but warned repeatedly of that it will result in higher taxes and other financial burdens.
"We have failed to listen to America," said House Republican leader Rep. John Boehner.
As the House met Sunday, a shouting band of protesters outside the Capitol dramatized their opposition, and one man stood up in the House visitor's gallery shouting, "Kill the bill" before he was ushered out - evidence of the passions the yearlong debate over health care has stirred.
Obama's quest to overhaul health care seemed at a dead end two months ago, when Republicans won a special election to fill the late Edward Kennedy's Massachusetts Senate seat, and with it, enough votes to prevent a final vote.
But the White House, House Speaker Nancy Pelosi and Senate Majority Leader Harry 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.