Speaker Nancy Pelosi is joined by House Majority Leader Steny Hoyer, left, and Rep. George Miller after passage of the health insurance bill.
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WASHINGTON - In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry.

The final vote was 220-215. Only one Republican — Rep. Joseph Cao of Louisiana — voted for the measure; 39 Democrats voted against it.

Obama praised the House in a statement and said he is "absolutely confident" that the Senate will pass its version of the legislation. "I look forward to signing it into law by the end of the year," he said.

Passage was an exhilarating triumph for Obama and House Speaker Nancy Pelosi, who earlier likened the bill to passage of the government's Social Security pension program in 1935 and Medicare health insurance for the elderly 30 years later...

But the Senate has yet to begin floor debate on its own version of insurance reform. That debate may be weeks away, with Senate Democratic leaders still negotiating over the details of their legislation.

If the Senate enacts its bill, conferees from House and Senate would then meet to negotiate a final compromise measure.

That compromise would then need to be voted on by the House and Senate.

So Democratic members from Republican-leaning districts who cast a difficult vote Saturday night for the House bill will face yet another tough vote in several weeks.

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 fixing and market allocation.

Federally regulated marketplace
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.

"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.

The vote added to the Democratic bill an amendment sponsored by Rep. Bart Stupak, D-Mich., and others, that prohibits individuals who receive insurance subsidies from purchasing any plan that pays for elective abortions.

House Democratic leaders agreed Friday night to allow a floor vote on the Stupak amendment to the bill in order to win the support of about three dozen Democrats who feared that the original bill would have subsidized abortions.

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

A cheer
A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed.'

From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."  

Nearly 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.

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