Obama clinches vote on historic healthcare bill

The vote in the House was 219-212. Republicans were unanimously opposed. The Bill now goes to President Barack Obama for his signature.

The action capped a long quest by Mr Obama and the Democrats to

overhaul the system and reshape a sixth of the US economy. Congressional officials said they expected Mr Obama to sign the bill this week.

"We proved that we are still a people capable of doing big things," President Mr Obama said on TV. "We proved that this government – a government of the people and by the people – still works for the people."

After more than a year of political combat – certain to persist into the autumn election campaign for control of Congress – debate on the House floor fell along predictable lines.

"We will be joining those who established Social Security, Medicare and now, health care for all Americans," said Speaker Nancy Pelosi before the vote, referring to the government's pension programme and health insurance for the elderly.

Republicans opposed the measure as a takeover of government health care that would cut Medicare for the elderly and raise taxes by nearly 1 trillion dollars (665.8bn) combined.

"We have failed to listen to America," John Boehner, the Republican leader, said before the vote.

Earlier, the House argued its way through a thicket of Republican objections towards a vote on the bill to extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138bn (91.9bn)over a decade.

A shouting band of protesters outside the Capitol dramatised their opposition, and one man stood up in the House visitors' gallery shouting, "Kill the Bill" before he was ushered out – evidence of the passions the year-long debate over healthcare has stirred.

Mr Obama lobbied by phone from the White House, then took the crucial step of issuing an executive order that satisfied a small group of Democrats who demanded that no federal funds should be used for elective abortions.

Over and over, Democrats stressed the historic nature of the day. The measure represents the biggest expansion of the social safety net since Medicare and Medicaid were enacted in 1965 during President Lyndon B Johnson's administration to provide government-funded healthcare coverage to the elderly and poor.

"Healthcare isn't only a civil right, it's a moral issue," said Democrat Patrick Kennedy.

He said his late father, Senator Edward Kennedy, had worked his entire career for nationwide healthcare, and President John F Kennedy before him.

Mr Obama has said often that presidents of both parties have tried without success to achieve national health insurance, beginning with Theodore Roosevelt early in the 20th century.

The 44th President's quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election to fill Edward Kennedy's Massachusetts Senate seat, and with it, enough votes to prevent a vote.

But the White House, Speaker Pelosi and Senate Majority Leader Harry Reid came up with a rescue plan that required the House to approve the Senate-passed measure.

Under the legislation, most Americans would be required to purchase insurance and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 (58,688) a year pay their premiums.

The legislation would also usher in a significant expansion of

Medicaid, the state healthcare programme for the poor.

The insurance industry would come under new federal regulation. It would be forbidden from placing lifetime dollar limits on policies, from denying coverage because of pre-existing conditions and from cancelling policies when a policyholder becomes ill.

A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.

Once enacted, the two bills would create a series of so-called "insurance exchanges" beginning in 2014 where self-employed people and small businesses could pool together to shop for health care coverage.

To pay for the changes, the legislation includes more than $400bn (266.3bn) in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 (133,155) and couples over $250,000 (166,444).