The bill, the most sweeping social legislation since the Great Society programs of the 1960s and the centerpiece of the first year of President Barack Obama's administration, also represents a milestone -- near universal health insurance -- that has eluded presidents since Theodore Roosevelt more than a century ago.
The final tally, which adhered almost entirely along party lines, was 219 "yes" votes and 212 "no" votes. Not one Republican voted for the measure, which was a vote on a similar bill already approved by the Senate.
Many Democrats who supported the bill called it a long overdue achievement that will provide quality health care to virtually all Americans.
"Health care isn't only a civil right, it's a moral issue," Rep. Patrick Kennedy, D-R.I., said before the vote. He said his late father, Sen. Edward M. Kennedy, D-Mass., had worked his whole career for nationwide health care, as had President John F. Kennedy before him, the Associated Press reported.
Republicans criticized the bill as an unwarranted intrusion by the federal government into health care that would cut Medicare and raise taxes by nearly $1 trillion combined. Rep. David Dreier, R-Calif., who was critical of the Democrats' parliamentary maneuverings before the vote, said "the greatest outrage has always been for the bill itself," the AP said.
The outcome of the vote was uncertain as late as Sunday afternoon, with some conservative Democrats withholding their support because of concerns that the bill would allow the use of federal dollars to pay for abortions. When Obama promised to issue an executive order "to ensure that federal funds are not used for abortion services," passage of the bill was all but guaranteed.
The Senate passed its version of health reform legislation in December.
Before a final bill can be sent to Obama for his signature, the Senate must sign off on a package of House-approved changes to the Senate bill. A simple majority vote in the Senate would complete the process, paving the way for Obama's signature.
In the days leading up to the vote, health-care and public policy experts said passage of the bill really boiled down to one simple tenet: More Americans should have access to health insurance.
"The big impact is the coverage of 31 million uninsured individuals, and that includes about 15 million people with incomes below 133 percent of the poverty line [through an expansion of Medicaid]," Karen Davis, president of the Commonwealth Fund in New York City, said last week. "Basically, it makes a big dent in the number of uninsured and underinsured. That's far and away the biggest impact."
Thomas R. Oliver, associate director for health policy at the University of Wisconsin Population Health Institute, described the legislation as "a dramatic effort to really get at the core questions of accessibility and affordability of coverage."
Though stating that the legislative effort "is a sweeping change," Oliver also acknowledged that the bill, once passed, would be "disappointing to many who believe that the most constructive thing that we need to do as a nation is to bring all Americans into adequate, basic insurance coverage."
He does, however, believe the bill is a step toward that goal.
As it stands, the bill would place penalties on many businesses that don't provide coverage for their workers, according to the AP. While that could mean millions of new paying customers for hospitals, doctors, drug companies and insurers, Medicare cuts would mean that hospitals would have to operate more efficiently to stay afloat. Insurance companies would face unprecedented federal regulation, and health-care industries would be hit with new federal taxes, according to the wire service.
Implementation of the bill's provisions would be staggered over the next four years and beyond.
"Most of the insurance expansion won't happen till 2014, although there will be some changes in the rules right away," Davis said.
As the bill now stands, taking effect in 2010:
* Insurers would no longer be able to exclude high-risk individuals from getting a policy, nor would they be able to dump people who develop medical problems. "That guarantees the availability of coverage for people with serious health problems," Davis said.
* Young adults, up to age 26, would be eligible for coverage under their parents' policies, she said.
* Ceilings on annual or lifetime benefits would be eliminated, Davis said.
Longer-term changes would include:
* Setting up regional health insurance exchanges that various groups -- including self-employed people, those without employer-based health coverage, high-risk individuals and small businesses -- could tap for coverage.
* Adopting portable health insurance, meaning people could take their coverage with them if they left a job, Davis said.
* Stricter regulation and scrutiny of the health insurance industry.
