The U.S. House of Representatives gave final approval to a sweeping healthcare overhaul on Sunday, expanding insurance coverage to nearly all Americans and handing President Barack Obama a landmark victory.
On a narrow and hard-fought 219-212 vote late on Sunday, House Democrats approved the most dramatic health policy changes in four decades. The vote sends the bill, already approved by the Senate, to Obama to sign into law.
The overhaul expands the government health plan for the poor, imposes new taxes on the wealthy and bars insurance practices such as refusing to cover people with pre-existing medical conditions.
Its passage caps a year-long political battle with Republicans that consumed the U.S. Congress and dented Obama's approval ratings, and fulfills a goal that has eluded Democrats since former President Bill Clinton's failed attempt in 1994.
Republican and industry critics said the 10-year $940 billion bill was a heavy-handed intrusion in the healthcare sector that will drive up costs, increase the budget deficit and reduce patients' choices.
Both parties geared up for another battle over the healthcare bill in the campaign leading up to November's congressional elections, and opponents across the country promised to challenge the legislation on the state level.
The overhaul, Obama's top domestic priority, would usher in the biggest changes in the $2.5 trillion U.S. healthcare system since the 1965 creation of the government-run Medicare health program for the elderly and disabled.
It extends health coverage to 32 million uninsured, covering 95 percent of all Americans, gives subsidies to help lower-income workers pay for coverage and creates state-based exchanges where the uninsured can compare and shop for plans.
Major provisions such as the exchanges and subsidies would not kick in until 2014, but many of the insurance reforms like barring companies from dropping coverage for the sick will begin in the first year.
The vote followed days of heavy lobbying of undecided House Democrats by Obama, his top aides and House leaders. The narrow victory was clinched earlier on Sunday by a deal designed to appease a handful of Democratic opponents of abortion rights.
Under the deal, Obama will issue an executive order affirming government restrictions on the use of federal funds for abortion would not be changed by the healthcare bill.
That pledge won the support of Representative Bart Stupak and a handful of other House Democratic abortion rights opponents, who had threatened to vote against the Senate-passed bill because they said its abortion restrictions were not strong enough.