WASHINGTON - The Democratic-controlled House narrowly passed far-reaching health care legislation, handing President Barack Obama a hard-won victory on his chief domestic priority though the road ahead in the Senate promises to be tougher.
The 220-215 House vote late Saturday cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress.
House Republicans were nearly unanimous in opposing the plan that would expand coverage to tens of millions of Americans who lack it and place tough new restrictions on the insurance industry.
But in the Senate, more than a simple majority is needed for passage, and several centrist Democrats still have reservations, particularly about establishing a government-sponsored insurance program, or public option, to compete with private insurers.
"The House bill is dead on arrival in the Senate," Republican Sen. Lindsey Graham of South Carolina said Sunday. "It was a bill written by liberals for liberals."
A Democratic colleague, Sen. Jack Reed of Rhode Island, predicted an overhaul would pass the Senate because "it's essential" to the country's economic success and people's quality of life. "It will take time," he added.
Obama, who went to Capitol Hill earlier on Saturday to lobby wavering Democrats, praised the House in a statement and said he is "absolutely confident" that the Senate will pass its version of the legislation. "I look forward to signing it into law by the end of the year," he said.
The House bill is projected to expand coverage to 36 million uninsured. The United States is the only developed nation that does not have a comprehensive national health care plan.
"It provides coverage for 96 per cent 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.
A triumphant House Speaker Nancy Pelosi likened the legislation to the passage of the government's Social Security pension program in 1935 and Medicare health insurance for the elderly 30 years later.
Republicans detailed their objections across hours of debate on the 1,990-page, 10-year $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,"' said Rep. Candice Miller of Michigan. She added that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.
In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups.
Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.
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 because of medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. The industry would also lose its exemption from federal antitrust restrictions on price fixing 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 companies.
Graham said he thinks the government option "will destroy private health care. Nobody in this country in the insurance business can compete with a government-sponsored plan, where the government writes the benefits and politicians will never raise the premiums."
Sen. Joe Lieberman, an independent from Connecticut, said that "if the public option plan is in there, as a matter of conscience, I will not allow this bill to come to a final vote because I believe the debt can break America and send us into a recession that's worse than the one we're fighting our way out of today."
The House bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats, mostly moderates from Republican-leaning states.
Over all, the bill envisioned the most sweeping set of changes to the U.S. health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.
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 per cent on income over $500,000 in the case of individuals and $1 million for families.
A Republican alternative to the Democrats' House bill was rejected on a near party line vote of 258-176.
From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."
Senate Democrats will need 60 out of 100 votes to end debate and bring legislation to a final vote.
If the Senate does pass a bill, it would have to be reconciled with the House version by a panel of lawmakers from both chambers before the legislation is put up for final approval.
The U.S. government provides coverage for the poor, elderly and military veterans, but most Americans rely on private insurance, usually provided through their employers. But with unemployment climbing above 10 per cent, many Americans are losing their health insurance when they lose their jobs. At the same time, the deepening budget deficit has made it difficult for lawmakers to support costly new programs.
Graham and Reed were on CBS television's "Face the Nation." Lieberman appeared on "Fox News Sunday."
Associated Press writers David Espo, Phil Elliott and Alan Fram contributed to this report.