The US House of Representatives approved a sweeping healthcare reform bill yesterday, backing the biggest health policy changes in four decades and handing President Barack Obama a crucial victory.
On a narrow 220-215 vote, including the support of one Republican, the House endorsed a bill that would expand coverage to nearly all Americans and bar insurance practices such as refusing to cover people with pre-existing conditions.
Most Republicans criticized its $1 trillion (£600bn) price tag, new taxes on the wealthy and what they said was excessive government interference in the private health sector.
Democrats cheered and hugged when the 218th vote was recorded, and again when House Speaker Nancy Pelosi pounded the gavel and announced the results.
The battle over Obama's top domestic priority now moves to the US Senate, where work on its own version has stalled for weeks as Senate Democratic leader Harry Reid searches for an approach that can win the 60 votes he needs.
Any differences between the Senate and House bills ultimately will have to be reconciled, and a final bill passed again by both before going to Obama for his signature.
"Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation," Obama said in a statement after the vote.
"I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year," he said.
The overhaul would spark the biggest changes in the $2.5trillion (£1.5tr) US healthcare system, which accounts for one sixth of the US economy, since the creation of the Medicare government health program for the elderly in 1965.
The vote followed days of heavy lobbying of undecided Democrats by Obama, his top aides and House leaders. The narrow victory was clinched early on Saturday by a deal designed to mollify about 40 Democratic opponents of abortion rights.
Democrats had a cushion of 40 of their 258 House members they could lose and still pass the bill. In the end, 39 Democrats sided with Republicans against it.
The lone Republican to vote in favor of it was first-term Representative Anh Cao of Louisiana. "It was a bipartisan vote," Democratic leader Steny Hoyer said to laughter among fellow Democrats afterward.
The landmark vote was a huge step for Obama, who has staked much of his political capital on the healthcare battle. A loss in the House would have ended the fight, impaired the rest of his legislative agenda and left Democrats vulnerable to big losses in next year's congressional elections.
Obama traveled to Capitol Hill yesterday morning to meet with House Democrats and emphasise the vital need for the healthcare reform bill.
Republicans and Democrats battled in sometimes testy debate through the day and into the night over the bill, which would require individuals to have insurance and all but the smallest employers to offer health coverage to workers.
It would set up exchanges where people could choose to purchase private plans or a government-run insurance option bitterly opposed by the insurance industry, and it would offer subsidies to help low-income Americans buy insurance.
Congressional budget analysts say the bill would extend coverage to 36 million uninsured people living in the United States, covering about 96 percent of the population, and would reduce the budget deficit by about $100bn (£60bn) over 10 years.
"We can't afford this bill," said Republican Representative Roy Blunt. "It's a 2,000-page road map to a government takeover of healthcare."
Democrats rejected on a 258-176 vote the much smaller Republican healthcare plan, which focused on cost controls and curbing medical malpractice lawsuits but did not include many of the insurance reforms of the Democratic plan.
The House also approved on a 240-194 vote an amendment that would impose tighter restrictions on using federal funds to pay for abortions.
House Democratic leaders agreed to allow a vote on the amendment to mollify about 40 moderate House Democrats who threatened to oppose the overhaul without changes to ensure federal subsidies in the bill for insurance purchases were not used on abortion.
The move enraged Democratic abortions rights supporters, but they largely voted in favor of the bill in hopes they can remove the language later in the legislative process.