The US House of Representatives has given final approval to a sweeping health care overhaul, expanding insurance coverage to nearly all Americans and handing president Barack Obama a landmark victory. On a late-night 219-212 vote, House Democrats approved the most dramatic health policy changes in four decades. The vote sends the bill, already passed by the Senate, to Mr Obama to sign into law. The overhaul will extend health coverage to 32 million Americans, expand the government health plan for the poor, impose new taxes on the wealthy and bar insurance practices such as refusing to cover people with pre-existing medical conditions.
The vote capped a year-long political battle with Republicans that consumed the US Congress and dented Mr Obama's approval ratings, and fulfilled a goal that had eluded many presidents for a century - most recently Democrat Bill Clinton in 1994. "Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics," Mr Obama said during a late-night appearance at the White House.
"This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction. This is what change looks like," he said. House Democrats hugged and cheered in celebration as their vote count hit the magic number of 216, and chanted: "Yes we can." Every Republican opposed the bill, and 34 Democrats joined them in voting against it. Republican and industry critics said the $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 health care 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 health care revamp, Mr Obama's top domestic priority, would usher in the biggest changes in the $2.5 trillion US healthcare system since the 1965 creation of the government-run Medicare health program for the elderly and disabled.
It would require most Americans to have health coverage, give subsidies to help lower-income workers pay for coverage and create 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.
House Democrats also approved a package of changes to the Senate bill late on Sunday. The Senate will take up that package this week under budget reconciliation rules requiring a simple majority to pass. The changes include elimination of a controversial Senate deal exempting Nebraska from paying for Medicaid expansion costs, the closure of a "doughnut hole" gap in prescription drug coverage and modifications to a tax on high-cost "Cadillac" insurance plans.
Republicans said they would challenge those changes in the Senate through parliamentary points of order and believed they could block its passage. *Reuters