WASHINGTON — The House on Saturday passed, by a 220-215 vote, historic health care overhaul legislation that would require virtually all Americans to obtain health insurance and create a government-run health insurance plan to help them do so.
If passed by the Senate, the bill would bring about the most sweeping changes in the American health care system since Medicare was created 44 years ago.
Supporters of the measure burst into cheers and applause on the House floor as it became clear the measure had won, but the vote was excruciatingly close, just two more than the bare minimum needed. One Republican, Joseph Cao of Louisiana, voted for the bill; 39 Democrats voted against it.
President Barack Obama made a personal plea for passage before the all-day debate began.
Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority. While the session was private, he later said he had told the rank and file "that opportunities like this come around maybe once in a generation. … This is their moment, this is our moment, to live up to the trust that the American people have placed in us."
Participants also said Obama had referred to Thursday's shooting rampage at Fort Hood, Texas, in which 13 people were killed. His remarks put in perspective that the hardships soldiers endure for the country are "what sacrifice really is," as opposed to "casting a vote that might lose an election for you," said Rep. Robert Andrews, D-N.J.
"Now is the time to finish the job," Obama said in brief remarks in the White House Rose Garden after the meeting.
But the job is far from finished. The Senate hopes to act by the end of the year, and if successful, the two Houses would then craft a compromise that would need approval of each chamber.
The House vote came with a warning: Getting enough votes later this year or early in 2010 will not be easy. Thirty-nine Democrats, most from conservative districts or freshmen who narrowly won their 2008 elections, voted against the House bill, joining 176 Republicans.
Two Florida Democrats were among the defectors, Suzanne Kosmas of the Orlando area and Allen Boyd of Monticello. Both represent fairly conservative areas.
Boyd, a member of the moderate Blue Dog caucus, has been long squeamish about the size of the proposal and the inclusion of a government-run insurance option. For Kosmas, the bill was an election liability. She won her seat in 2008 by beating incumbent Republican Tom Feeney, and the GOP has been pining to retake the spot in 2010.
Otherwise, Florida voted along party lines. Tampa Democrat Kathy Castor, who played a role in expanding medical school residencies for Florida and better consumer protections against Medicare Advantage marketing, said it was historic, "along the lines of Social Security and Medicare. This is the next step, the one that has been missing for decades."
Rep. Gus Bilirakis, R-Palm Harbor, bemoaned the $1.1 trillion price tag and said measures would hurt small businesses by requiring more coverage. "I'm worried about the loss of jobs." He also faulted cuts to Medicare Advantage, which is subsidized at a higher rate than Medicare. Bilirakis said his office phones had been ringing all day and five out of six constituents opposed the plan.
Democratic leaders pressed well into Saturday night for more party support. Obama's campaign arm, Organizing for America, even tried to gain Republican support by sending e-mail to voters in districts that voted for Obama over John McCain last year. "With the big vote happening in as little as a few hours, there's not a moment to lose," read the e-mail. Rep. C.W. Bill Young, R-Indian Shores, was among the targets but it did not resonate with him.
In addition to creating the so-called public option government-run insurance program, the House-passed bill would bar insurers from denying people coverage because of pre-existing conditions and set up health care "exchanges," or marketplaces, where consumers could easily shop for coverage.
The changes are expected to mean that by 2019, 96 percent of eligible Americans would have health insurance, up from 83 percent now.
A big boost came from a deal to bar coverage by government-subsidized insurance policies of elective abortions.
As originally written, the measure would have required insurers to separate public and private money, so that only private funds could be used for elective abortions. After tense negotiations Friday night — with White House officials and representatives of the U.S. Conference of Catholic Bishops as well as key Democratic members of Congress — House Democratic leaders agreed to allow a vote Saturday on sweeping changes to the abortion provision.
The measure was approved, 240-194, as 64 Democrats joined 176 Republicans to back the change.
The change would permit abortion coverage for people receiving federal aid for their insurance only in the case of rape or incest or when the mother's life is endangered. That change is consistent with a 1970s-era federal law governing public funding of abortion.
Under the new provision, only people buying private insurance with their own funds would have an elective abortion covered.
GOP members then pushed their own plan, which would make it easier for small businesses to band together to purchase competitively priced coverage, allow consumers to buy policies across state lines, and effect strong medical malpractice reforms.
It was easily defeated on a largely party line vote, 258-176.
During his half hour appearance on Capitol Hill Saturday, Obama took no questions from lawmakers, but his presence was a vivid reminder that the president has put health care overhaul at the top of his domestic agenda — a change that has eluded presidents for nearly a century.
"He came here to say, 'This is what we said we would do in the campaign. Let's do it,' " said House Majority Leader Steny Hoyer, D-Md.
Times staff writer Alex Leary and the Associated Press contributed to this report.