House Passes Sweeping Health Care Bill

(AP / WASHINGTON) — The Democratic-controlled House has passed historic health care legislation to provide medical coverage to millions more Americans.

Most Americans would be required to carry insurance and large employers would be obliged to cover their employees. (Read TIME's "5 truths about health care in America")

After months of struggle, Speaker Nancy Pelosi projected confidence and likened the bill to the creation of Social Security in 1935 and Medicare 30 years later.

"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," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the runup to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

Passage cleared the way for a Senate debate expected to begin in several days. Democratic leaders have been working on a self-imposed deadline for passing a final compromise, but Senate Majority Leader Harry Reid signaled recently that may slip.

United in opposition to the health care bill, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, `this is making me sick,'" jabbed Rep. Candice Miller, R-Mich., adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

But with little or no doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting "death panels" to hasten the demise of senior citizens.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

The nation's drug companies generally support health care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.

Over all, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority. While the session was private, he later said he had told the rank and file "that opportunities like this come around maybe once in a generation.... This is their moment, this is our moment, to live up to the trust that the American people have placed in us..."

"I urge members of Congress to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America," he said.

Participants also said Obama had referred to this week's shooting rampage at Fort Hood, Texas, in which 13 people were killed. His remarks put in perspective that the hardships soldiers endure for the country are "what sacrifice really is," as opposed to "casting a vote that might lose an election for you," said Rep. Robert Andrews, D-N.J.

See TIME's Pictures of the Week