The US Congress passed an historic health care overhaul Sunday, handing President Barack Obama a landmark win and taking the United States closer than ever to guaranteed coverage for all Americans.
The Democratic-held House of Representatives voted 219-212 to approve a Senate-passed bill aimed at extending coverage of tens of millions of American who currently lack it in the most sweeping social policy shift in four decades.
Obama, who made the overhaul his top domestic priority, was to sign the legislation this week, even as his Republican foes warned Democrats would pay a steep political price in November mid-term elections.
As hundreds of angry protesters outside the Capitol chanted "Kill the Bill," the House also voted 220-211 for a free-standing package of changes to the bill, which the Senate was to take up this week.
Democrats used their majority to muscle the measure through, losing 34 conservative party members who joined all 178 Republicans to oppose the bill. Related article: History of US health care reform battle
"This bill is complicated, but it's also very simple: Illness and infirmity are universal, and we are stronger against them together than we are alone," Democratic House Majority Leader Steny Hoyer said before the vote.
"This trillion-dollar overhaul will take the America we know and love in the wrong direction," said Representative Eric Cantor, the number two House Republican.
Together, the Senate bill and package of changes would remake US health care a century after then-president Teddy Roosevelt called for a national approach, extending coverage to some 32 million Americans who currently lack it.
It would ban insurance company practices like denying care for preexisting conditions, imposing lifetime caps on coverage, while providing subsidies to buy private insurance in newly-created marketplaces called "exchanges." Facts: Obama health care plan.
Republicans denounced the plan, and made frequent trips to a Capitol balcony to cheer on the protesters, who chanted slogans like "Just Vote No," "You Work For Us," and "in November, we'll remember."
Inside, Republican Representative Paul Ryan leveled angry charges that the legislation would crush the free market in the heavy hand of government while raising taxes and creating a bevy of inefficient agencies.
"This bill is a fiscal Frankenstein," he said. "It's not too late to get it right, let's start over, let's defeat this bill."
Republicans also vowed to keep up the fight in the Senate -- the next battleground -- and repeal the broadly unpopular bill if they win back majorities in November.
After a year of often bitter debate, Obama cleared the way to his victory with an 11th-hour deal to sign an executive order reaffirming a longstanding US ban on government funding for abortions, winning support for the bill from a group of conservative Democratic holdouts.
"I've always supported health care reform," said the group's leader, Democratic Representative Bart Stupak, flanked by other anti-abortion lawmakers. "This bill is going to go through."
The breakthrough ensured that Obama's Democratic allies could lock down the 216 votes needed to pass the sweeping legislation, on which Obama had staked much of his future effectiveness and even his political legacy.
The Senate was expected this week to take up the changes and approve them separately, under rules that prevent Republicans from using a parliamentary tactic, the filibuster, to indefinitely delay and therefore kill the measure.
Senate Republicans planned to besiege the legislation with what one of their leaders warned would be "hundreds of amendments" in a bid to derail it.
"Senate Republicans will now do everything in our power to replace the massive tax hikes, Medicare cuts and mandates with the reforms our constituents have been calling for throughout this debate," said Senate Republican Minority Leader Mitch McConnell.
Recent opinion polls have painted a confusing picture, with respondents expressing strong support for individual elements of the bill, but with large numbers saying they oppose the overall measure.
Democrats have highlighted the independent Congressional Budget Office's estimate that the bill would cost 940 billion dollars over the next 10 years, while cutting 143 billion dollars from the bloated US deficit through 2019 and 1.2 trillion over the following decade.
The House vote on what Obama has called "the toughest insurance reforms in history" would come a century after president Theodore Roosevelt first called for a national approach to US health care.