WASHINGTON — Congress succeeded in a century-long quest for far-reaching health-care reform as House Democrats last night approved a plan to expand coverage to 32 million people and overhaul the nation's health-care system to contain costs.
The plan cleared the House on a 219-212 vote, with Republicans unanimous in opposition. They were joined by 34 Democrats. The 435-member House has four vacancies.
“This is what change looks like,” President Obama said in televised remarks a few moments after the vote, stirring memories of his 2008 campaign promise of “change we can believe in.”
“I want to thank every member of Congress who stood up tonight with courage and conviction to make health care reform a reality,” he said as the top members of his own health care team stood beaming nearby. “I know this wasn't an easy vote for a lot of people. But it was the right vote.”
Congressional officials said they expect the President to sign the bill as early as tomorrow.
A second measure — making changes in the first — was approved by the House late last night. That measure goes to the Senate, where Democratic leaders said they had the votes to pass it.
The bill affects every man, woman, and child in the United States in some way.
Democrats predicted the bill would rank with other great social legislation of recent decades.
“We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans,” House Speaker Nancy Pelosi (D., Calif.) said.
Republicans agreed the bill would affect everyone in America, but warned of the burden imposed by more than $900 billion in tax increases and Medicare cuts.
“We have failed to listen to America,” said Rep. John Boehner of Ohio.
Debate touched on many highly charged issues in American life.
A handful of anti-abortion Democrats, including Rep. Marcy Kaptur (D., Toledo), held up a final deal until yesterday afternoon.
Miss Kaptur heralded the measure as “a new day in America.”
“The bill overall addresses a serious problem before the country today, which is that people are finding their insurance plans unaffordable,” Miss Kaptur said.
Among Ohio congressmen, Miss Kaptur voted yes while Republicans Bob Latta and Jim Jordan voted no.
Michigan Democrats John Dingell and Mark Schauer both voted in favor of the overhaul.
Over the next 10 years, the bill would set in motion a series of changes to the health insurance market that would translate into the biggest expansion of coverage since Medicare and Medicaid were created in 1965, and the most ambitious effort ever to restrain health-care costs.
Presidents as far back as Theodore Roosevelt have rued the nation's approach to health coverage.
The system serves relatively well the 150 million Americans who receive health insurance through their jobs but provides few affordable options for people who work part time, are self employed, or work for companies that don't offer health benefits.
Mr. Obama conveyed to wavering House Democrats who visited the White House in recent days that he put his presidency at risk by pushing the House to act on the Senate bill. The last issue resolved before the vote was whether federal subsidies in the bill could be used to pay for policies that provide abortion services.
A handful of anti-abortion Democrats feared that the Senate language didn't provide adequate restrictions, and they refused to vote for the legislation unless the firewall was made more secure.
The President agreed to issue an executive order clarifying the ban on federal funding of abortion, convincing Rep. Bart Stupak (D., Mich.) and six colleagues to support the health-care overhaul.
The White House was scheduled to issue the executive order after the bill was signed.
The House first approved the legislation that cleared the Senate on Christmas Eve.
That measure would devote $940 billion over the next decade to expanding insurance coverage, with the major changes occurring in 2014.
An estimated 24 million people who lack access to affordable coverage through the workplace would be eligible for tax credits to buy insurance on new state-based exchanges.
Nearly anyone who earns less than 133 percent of the federal poverty level — an estimated 16 million people — would become eligible for Medicaid.
For the first time, individuals would pay a price for refusing to buy insurance, facing fines of at least $750 a year starting in 2014.
Employers with more than 50 workers that do not provide coverage may also face fines.
Medicare, the federal health program for people over 65, would undergo significant changes intended to deliver care more efficiently and at a lower price, with the aim of using the nation's largest insurance plan to force doctors, hospitals, and other private-sector players to follow suit.
Medicare Advantage, a form of Medicare provided by private insurance companies to about 11 million seniors, would lose nearly $120 billion over the next decade, probably forcing providers to drop popular add-on benefits such as gym memberships.
The legislation also includes smaller changes that would take effect this year.
In six months, new policies would have to permit adult children to stay on their parents' policies until they turn 26.
Small businesses with fewer than 25 employees and average annual wages of up to $50,000 would receive tax credits to offset the cost of buying insurance for their workers.
In six months, all new plans will have to cover the full cost of preventive care, including annual physicals and children's immunizations. Insurers wouldn't be able to require prior approval for patients who need to see gynecologists or go to emergency rooms.
Children with medical conditions would no longer be denied coverage, and states would receive $5 billion to create high-risk insurance pools to provide affordable coverage to adults with preexisting conditions.
For seniors, the bill would immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly.
Many provisions of the Senate bill would be altered by a separate package of amendments that the House approved late last night.
Compared with the Senate bill, that measure offers more generous subsidies to people eligible for federal help buying insurance.
Tax credits would be available to families earning as much as 400 percent of the poverty level — or about $88,000 a year for a family of four — who would be assured of spending no more than 9.5 percent of their income on health insurance premiums in 2014.