House Democrats rallied late Sunday night to pass President Obama's landmark health care overhaul plan and send to the president's desk the politically risky initiative, which Republicans vow to wield against the Democrats in November's mid-term elections.
A companion package of repairs to the bill now heads to a Senate fight. But regardless of the outcome there, Mr. Obama's yearlong struggle for his signature initiative is just a stroke of his pen away from becoming law.
The Senate's health care bill squeaked through the House in a 219-212 vote, with 34 Democrats joining all 178 Republicans in opposition after a last-minute White House executive order convinced a small group of pro-life Democrats that the bill wouldn't fund abortions. The companion "fixes" bill passed 220 to 211, with 33 Democrats joining all 178 Republicans in opposition.
Democrats hailed the vote as one of the most significant change in American social policy since the creation of Medicare in 1965 or Social Security in 1935.
"This is an American proposal that honors the traditions of our country," House Speaker Nancy Pelosi said, adding that access to health care is in the same league as the Declaration of Independence's claims about the inalienable rights to "life, liberty and the pursuit of happiness."
The 10-year, $940 billion overhaul plan aims to reshape the nation's health system by imposing new reforms on the insurance industry and guaranteeing insurance coverage to nearly all Americans with hopes of reducing health care costs and the federal deficit.
"This is what change looks like," Mr. Obama said at the White House shortly after the vote, which he watched in the Roosevelt Room with Vice President Joseph R. Biden Jr.
Outside the Capitol, a few hundred protesters shouted "Kill the bill." Walking from a House office building to the Capitol on Sunday afternoon, Mrs. Pelosi linked arms with Rep. John Lewis, a Georgia Democrat who walked in the civil rights marches in Selma, Ala., in the 1960s and who said he was called a racial epithet by health care protesters on Saturday.
Republicans called it an isolated incident and maintained their opposition to the health reform plan.
They argue that cuts to Medicare would undoubtedly hurt seniors' coverage, that insurance premiums for all Americans would spike, and that Democrats won't be able to make good on Mr. Obama's often-repeated promise that "if you like your plan, you can keep it."
"The decisions we make will affect every man, woman and child in this nation for generations to come," Minority Leader John A. Boehner said. "This bill is not what the American people need."
Mr. Boehner and Sen. Jim DeMint, South Carolina Republican, separately promised to introduce legislation to try to repeal the plan.
Mr. Obama, in his pitch to Democrats on Capitol Hill in recent weeks, said that much of his presidency is on the line with passage of his overhaul plan. It marks the most significant legislative accomplish of his presidency.
But it would be a victory with a large asterisk. The Senate promised House members that it will be able to pass a companion bill to "repair" controversial provisions in the bill, such as a tax on high-cost insurance plans and state-specific deals that critics say were meant to buy votes.
Mr. Obama could sign the Senate bill into law immediately. But doing so without the Senate repair bill would likely anger House members.
The debate over how to reform the $2.5 trillion health care industry has taken on a deeply partisan tone for more than a year. Many of the moderate Democrats who won Republican-leaning districts on Mr. Obama's coattails in 2008 acknowledged that their support may cost them their jobs this November as the overhaul hasn't polled well.
Democrats say that support will shift once Americans see the plan's benefits -- the poor will get tax credits to help them meet the requirement to buy insurance coverage; their insurance company won't be able to impose lifetime or annual caps on coverage or deny coverage because of pre-existing conditions; young adults can stay on their parents' plan until age 26; and Medicare's gap in drug coverage will be filled.
It's paid for through cuts to Medicare funding, which Democrats say will only cut waste and fraud, and a new Medicare tax on unearned income, such as investment profits, of couples making over $250,000 and individuals making over $200,000.
Abortion threatened to hold up the vote until almost the last minute.
A group of about 10 pro-life Democrats said they wouldn't vote for the Senate plan unless they had a guarantee that it wouldn't allow for federal funding of abortions. They were concerned the bill would allow federal tax subsidies to fund insurance policies that cover the procedure and that funding for community health centers would not come with a prohibition on covering abortions.
But their objections were met with an executive order Mr. Obama issued on Sunday affirming that the bill wouldn't do so.
Catholic groups have been divided over whether the Senate bill would authorize the federal funding of abortions, with the U.S. Conference of Catholic Bishops staunchly opposed to the Senate plan; but others, such as a group of hundreds of nuns, endorsed the plan last week.
Catholic Advocate, a 501(c)(3) lobbying group, said Sunday that passing the Senate bill would account for one of the greatest expansions of abortion since the landmark Roe v. Wade Supreme Court ruling and promised to contest House members who supported it.
But the executive order was thought to be enough to push Democrats over the 216 mark required for passage. The companion reconciliation bill would remove the Senate's tax on high-cost insurance plans, federal funding for Nebraska's Medicaid costs and other problems House members had with the Senate plan.
The Senate is expected to start work on the bill on Tuesday.
Over the weekend, Democrats decided against using a controversial procedure, called "deem and pass," that would have allowed both bills to pass with one vote. Republicans had called it a parliamentary trick. The vote required House members to take a bit of a leap of faith that the Senate was going to be able to deliver on the companion bill.
They now have no leverage left since the Senate bill can go to Mr. Obama's desk and become law despite their grave misgivings about it.
Senate Democratic leaders are expected to easily come up with the 51 votes they need.
"There's a strong desire to do what's in that bill," Sen. Debbie Stabenow, Michigan Democrat, told reporters last week.
But it's a potentially difficult climb for the Senate as reconciliation rules allow Republicans to introduce an unlimited number of amendments and require each provision of the bill to affect the budget or be struck by the Senate's nonpartisan parliamentarian.
If the bill is changed at all, in the form of amendments or budget strikes, it will have to go back to the House for another vote, throwing another wrench into the process.
Republicans have promised a fight, warning they plan to put up every procedural obstacle they can. They've already eyed parts of the bill that they contend are not related to the budget and can be brought up as a violation of the so-called "Byrd" rule.
Mrs. Pelosi said Friday that she doesn't foresee any Byrd-rule violations surviving.
"We tried to have a 'Byrd' scrub," she said, but "the parliamentarian would not necessarily give us definitive answers on anything."
Republicans said Sunday they like their chances on an objection that the bill affects Social Security, which would be a violation of budget rules. If the parliamentarian agrees and the presiding officer of the Senate upholds the decision, Democrats would need 60 votes to override the decision. All 41 Republicans recently signed a letter saying they will object to overriding the parliamentarian.
"We've informed our colleagues in the House that we believe the bill they're now considering violates the clear language of Section 310g of the Congressional Budget Act, and the entire reconciliation bill is subject to a point of order and rejection in the Senate should it pass the House," said Don Stewart, spokesman for Senate Republican leader Mitch McConnell of Kentucky.