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The House of Representatives has approved a more than $1 trillion plan by majority Democrats to overhaul the U.S. health care system.
More than three dozen Democrats broke with their party, and all but one Republican opposed the measure, which marks a major victory in President Barack Obama's effort to improve the U.S. health care system.
About 12 hours after the House began its debate, the final tally late Saturday was 220 to 215, with 39 Democrats choosing to vote against their leadership, despite personal lobbying by President Obama to keep Democrats on board.
But Democrats were still able to assemble the 218 vote majority in the 435 member House required for passage.
Republicans decry cost
Republican opposition was not a surprise, with all but Louisiana Congressman Joseph Cao rejecting the bill on grounds that it would sharply increase the federal deficit, raise insurance costs, and give the government control of the health care system.
Estimated at more than $1 trillion over 10 years, the measure would require most employers to offer health insurance to employees, and prohibit insurance companies from denying coverage based on existing medical problems or impose limits on coverage.
Most contentious was the proposal for a government-run insurance option, also known as a public option, to give Americans a choice over private insurance companies.
Joe Barton of Texas was among Republicans framing the debate as a question of individual freedoms versus bigger government, saying, "So, there is a choice. Bigger government, more mandates, more control, less freedom, or lower costs, more opportunity, more freedom or more choice. I vote for more freedom."
Democrat Jim Moran of Virginia pointed out that the U.S. lags behind many other nations when it comes to health care. He said, "We are a great nation, a prosperous and compassionate one, but our health care system doesn't measure up to that greatness."
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Republican alternative defeated
Before the final vote, the House voted 258 to 176 to reject an alternative from Republicans. Democrats noted that it would insure only 3 million Americans, versus the 36 million helped by their measure.
Republican leader John Boehner said, "The bill that we are offering is a common sense approach that does take major steps in the right direction to bring down the cost of health care and to expand access."
After meeting with lawmakers and before leaving for the presidential retreat at Camp David, Maryland, President Obama described the House vote as a historic opportunity to fix a broken system.
"What is in our grasp right now is the chance to prevent a future where every day 14,000 Americans lose their health insurance and every year 18,000 Americans die because they don't have it," said the president.
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At a news conference, Speaker Nancy Pelosi said she had just received a phone call from the president, and she paid tribute to the president's leadership. She said, "I thanked the president for his tremendous leadership, because without President Obama in the White House this victory would not have been possible. He provided the vision and the momentum for us to get the job done for the American people."
To ensure support, Democratic leaders agreed to a bipartisan amendment, approved 240 to 194, prohibiting a future government-run insurance plan from offering abortion services, and barring anyone receiving federal subsidies from purchasing private plans that cover abortion.
Final bill still needs work
Approval switches the focus to the Senate, where Democrats face the difficult task of achieving a 60-seat majority to approve a version there. No date has been set yet for a health care debate in the Senate.
If both chambers can pass legislation, lawmakers would still have to work out differences between the versions before they could send a final bill to President Obama for signature, something he has said he wants to do before the year ends.