House Approves Sweeping Health Care Bill, Now All Eyes on Senate

WASHINGTON, Nov. 8, 2009— -- Democrats in the House of Representatives narrowly passed sweeping health care reform legislation Saturday night, with only one Republican joining in the vote and the minority party nearly unanimous in its opposition.

"Oh what a night!" Speaker Nancy Pelosi proudly proclaimed at a press conference immediately following passage of the health care bill.

The vote passed 220-215, with 39 Democrats voting against the bill, and one Republican supporting the sweeping plan, Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. A whoop went up on the Democratic side of the chamber when the vote exceeded the 218 majority needed to pass and when the final tally was read. Democrats counted down the last few seconds in unison as Pelosi banged the gavel and boomed the standard line with added emphasis, "The bill is passed!"

"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

United in opposition, minority Republicans cataloged their objections across hours of debate over the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, 'This is making me sick,'" Rep. Candice Miller, R-Mich., said of the bill, adding that Democrats were intent on passing a "jobs-killing, tax-hiking, deficit-exploding" bill.

The House passage of health care reform now moves attention to the Senate, where two bills have moved through committee and Majority Leader Harry Reid must rally support for a single, unified bill.

Obama Makes Personal Appeal

In a closed-door meeting with House Democrats earlier in the day, President Obama made an impassioned appeal for what he called "a big moment in history," urging passage of the health care reform bill. After the the bill passed, Pelosi thanked the president and emphasized the value of his personal lobbying.

"I thank him for his leadership," Pelosi said, in making passage of the bill possible. "He gave us the momentum to get this done and we're very proud of our success."

Obama reportedly told his fellow Democrats in that meeting that he knew they might face opposition from their constituents for this vote.

"It's tempting to say, 'I'm tired, it's hard, I'm getting beat up back in the district, it's just not worth it,'" Obama said, according to a source in the meeting. "If we do not get it done this year, we will not get it done anytime soon."

The battles over the creation of Social Security and Medicare, he said, were also hard fought. Supporters of those bills, like supporters of this one, were attacked and called socialists.

The president also made an appeal based on political calculation, pointing to newly sworn-in Rep. Bill Owens, who was sitting in the front row. Owens won a surprise victory in the special election Tuesday in New York's 23rd Congressional District.

"Think about Bill Owens. He could have dodged it [health care], but he didn't," the president said. "And guess what? Bill is sitting right here."

He also warned House Democrats that Republicans would go after them even if they break ranks and voted against the Democratic health care overhaul.

"Do any of you expect the Republicans not to go after you if you vote against this bill?" he asked during the closed-door session, according to a Democrat in the room.

At the end of his speech, Obama got a rousing ovation for saying, "I am absolutely confident that when I sign this bill in the Rose Garden, each and every one of you will be able to look back and say, 'This was my finest moment in politics.'"

Later in the Rose Garden, Obama repeated his message to Congress publicly.

"I reminded them that opportunities like this come around maybe once in a generation. Most public servants pass through their entire careers without a chance to make as important a difference in the lives of their constituents and the life of this country. This is their moment, this is our moment. ... This is our moment to deliver," the president said.

Sweeping Changes in the Legislation

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices, such as denying coverage on the basis of pre-existing medical conditions, would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

Critical support for the bill came earlier in the week notably from the influential senior citizens lobbying group AARP and the doctors' lobbying group the American Medical Association.

ABC News' John Parkinson, Sara Just and The Associated Press contributed to this report.