The House of Representatives voted 219 to 212 late Sunday night to approve a sweeping overhaul of the health insurance industry after more than a year of planning, debate, delay and frequent internal party disarray among Democrats in Washington. The vote represents a historic victory for Democrats, who have promised for decades to extend health insurance to the millions of Americans who do not have it. All Republicans and 34 Democrats voted against the bill.
"We proved that we are still a people capable of doing big things and of tackling big challenges," President Obama said in remarks shortly after the vote.
The legislation will prevent insurance companies from dropping or denying coverage based on a customer's medical history. It will also require every American to purchase health insurance and will penalize large businesses that do not provide insurance for their employees. By 2014, individuals will be able to shop for insurance on new health care exchanges, and will be subsidized by the government if they cannot afford it.
To pay for the reforms and expansion, the bill will increase fees on pharmaceuticals and medical devices; tax expensive insurance policies beginning in 2018; and expand Medicare payroll taxes to investment income.
Despite the bill's $940 billion, 10-year price tag, the Congressional Budget Office estimated that it would reduce the federal deficit by $130 billion in the next ten years, and by $1.2 trillion during the following ten years.
After the House voted to approve the Senate bill, it took up a package of "fixes" to the underlying Senate legislation, which some House Democrats had vocally opposed. The package included overhauling the student loan program, eliminating the "Cornhusker Kickback" to Nebraska, narrowing the effects of the excise tax and adding more funding for subsidies to make insurance more affordable. The House passed the amendment 220 to 211.
Earlier Sunday, Rep. Bart Stupak (D-Mich.) announced that he had come to an agreement with the White House on restrictions for abortion funding in the bills. The White House confirmed that the president would sign an executive order Sunday night explicitly stating that no funds from the health reform package would be used for abortion services or abortion coverage.
"We wanted to see health care reform," Stupak said Sunday afternoon. "But there was a principle that mattered more to us than anything and that was the sanctity of life."
Before the House voted, House Speaker Nancy Pelosi spoke from the House floor at the end of several hours of sometimes heated debate between Democrats and Republicans.
She quoted the late Sen. Ted Kennedy in calling health care reform "the great unfinished business of our society," but added, "unfinished until today." The speaker framed Sunday night's vote as a historic moment that would be remembered as the day that America defined health care to be a right and not a privilege.
"We tonight will make history for our country and progress for the American people," Pelosi said.
House Majority Leader Steny Hoyer called the bill a compassionate example of what it means to be American. "Illness and infirmity are universal," Hoyer said. "Our bodies may fail us, but our neighbors don't have to."
As much as House Democrats praised their bill, Republicans spoke out in fierce opposition to it.
Republican whip Rep. Eric Cantor accused President Obama and the Democrats of passing a bill that will bankrupt the country and of ignoring Americans' opposition to the bill in their fervor to pass it. "I have a message for those Americans -- we hear you," Cantor said. "We hear you loud and clear. Because we believe this government must stop spending money it doesn't have."
Rep. John Boehner, the top Republican in the House, excoriated Democrats for using tactics they had decried when they were in the minority.
"Can you say this bill was done openly, with transparency and accountability? Without backroom deals and struck behind closed doors, hidden from the people?" Boehner said as his voice grew louder. "Hell no you can't!"
In addition to the health care legislation and debate, the House also passed a major overhaul of the student loan industry. The legislation eliminates the role of private lenders, which have received billions of dollars in federal subsidies and guarantees over the last 35 years to encourage them to lend to students. Instead, students would now get their loans directly from the Department of Education starting July 1.
Now that the Senate health reform bill has passed the House, it will go to President Obama to be signed into law immediately. The package of fixes to the bill will go to the Senate, where debate will begin Tuesday.
Because the Senate will use budget reconciliation rules to pass the bill, no filibusters will be allowed, but Republicans can offer as many amendments as they want. If even one amendment passes, the package will have to go back to the House to be passed again and again, until the two chambers pass identical bills.
As the House voted Sunday, President Obama watched the proceedings from the White House's Roosevelt room with the vice president and several members of his staff. When the House reached the 216 votes needed to pass the bill, the AP reports, Obama cheered and reached over to White House Chief of Staff Rahm Emanuel to exchange a high-five.
Moments later, the president spoke to the press in the East Room of the White House, calling the bill "a reform package finally worthy of the people we serve."
"We rose above the weight of our politics," Obama said. "We pushed back on the undue influence of special interests. We didn't give in to mistrust or cynicism or to fear."
The president thanked Pelosi for passing the bill through the House, and spoke directly to the members of Congress who voted for it. "I know this wasn't an easy vote for people, but it was the right vote," he said. "This is what change looks like."
The day on Capitol Hill began with partisan passions vividly on display, as conservative protesters outside the Capitol shouted "Kill the bill!" and "We won't pay for murder!" at Democratic members of Congress as they arrived to begin the climactic debate and vote.
The protesters' numbers and volume grew as the day wore on, as did the suspense over whether Pelosi would be able to marshal the votes she would need to pass the final bill. Although several of the 20 undecided Democrats announced throughout the day how they would cast their votes, too few came out in favor of the legislation to guarantee its passage.
With the number of hold-outs dwindling and a 1 p.m. ET debate approaching, it became clear that Democrats could not pass health care reform without Stupak and his coalition of anti-abortion Democrats, who have said for months that they would not vote for reform without specific language guaranteeing that no federal funds from the bill would be used for abortion services.
After meeting well into the night Saturday on the abortion issue, Democratic leaders again huddled behind closed doors with Stupak's group Sunday morning. They also held separate meetings with the pro-choice caucus to make sure that any agreement with one side would not cost the votes of the other.
As rumors of an agreement popped up and were batted down throughout the afternoon, Pelosi gathered all of her Democratic members for one final meeting to urge them to stay committed to their votes. She noted that the House debate would come on the anniversary of Rep. John Lewis' march over the Pettus Bridge
in Selma, Ala., at the height of the Civil Rights era. She also said she would use the same gavel on the House floor Sunday that Rep. John Dingell (D-Mich.) used when Medicare passed the House in 1965.
Pelosi emerged from her meeting and walked members of her caucus from the Cannon house office building across the street to the Capitol, hand-in-hand with Rep. Lewis, to begin the final debate on the bill. Protesters, now numbering in the thousands, loudly shouted at the members as they filed past and waved signs saying, "Doctors not dictators!" and "Liberty or death!"
The formal debate on the bill began with Stupak's coalition still undecided, but all of the remaining Democrats and Republicans firmly entrenched in their "for" and "against" positions.
As the partisan show played out on the House chamber, the ultimate outcome of health care reform became clear when Stupak announced that he had indeed come to an agreement with the White House, and that the president would sign an executive order Sunday with the language the congressman had sought for months.
For Republicans looking to stop health care reform from passing the House at that point, there was little they could do but speak out against the bill and wait for the 2010 elections, which they believe will be a referendum on a bill they say Americans don't want.
Just before the votes, Rep. James Clyburn, the Democratic whip, reflected on what the bill would mean in the scope of his 18-year career in Congress and said he hadn't been particularly emotional about it until his teenage grandson sent him a text Saturday to wish him luck on the vote.
"It's personal with him," Clyburn said of his grandson, who has struggled with his health since his premature birth. "You don't expect a 15-year-old to be paying attention, but he is."