The bill passed 220 to 215, as Democrats counted down the seconds and broke into applause and cheers as the total was announced. One Republican, Rep. Joseph Cao of Lousiana, joined 219 Democrats in voting for the bill.
House Democratic leaders knew going into the vote that they could only afford to lose 40 members of their 258-member majority in order to ensure that the bill would receive the 218 votes necessary to pass. They came within one vote of that margin, with 39 Democrats voting against the bill.
The vote came after a full day of floor debate, and capped months of internal negotiations in the House.
Democrats said the $1.1 trillion legislation would provide health insurance coverage to 36 million more Americans, going a long way toward the goal of universal health coverage.
“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 83-year-old Rep. John Dingell, D-Mich., who has introduced national health insurance legislation in every session of Congress since 1955.
President Obama also praised the legislation in a statement after the vote.
“The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of health care for families, businesses, and the government,” he said.
The president also said he is confident that the Senate will pass its own version of the legislation, and that he looks forward to signing a comprehensive bill by the end of the year.
But Republicans, who voted nearly unanimously against the bill, decried the legislation.
“This is perhaps the worst bill I have seen come to the floor in my 11 years in Congress,” Rep. Paul Ryan, R-Wisc., said on the House floor before the vote, according to Politico.
The legislation would for the first time require nearly all Americans to purchase health insurance. It would aim to ensure that coverage is affordable by expanding Medicaid to cover everyone earning less than 150 percent of the poverty level, and providing subsidies to other lower and middle-income Americans. By 2013, it would create new marketplaces called health insurance exchanges where people who do not receive health insurance from their employers could use those subsidies to buy private health insurance or purchase a new government-run public insurance plan.
New regulations would ban health insurance companies from rejecting customers based on pre-existing conditions, from setting lifetime or yearly caps on benefits, and from the practice of rescission, or dropping customers when they become sick.
Beginning immediately, uninsured people with high-risk medical conditions could join temporary high-risk insurance pools until the new regulations kick in.
The new insurance exchanges and public plan would be put in place by 2013, at which point all employers with payrolls over $500,000 would be required to provide health coverage for their employees or pay a fine of up to 8 percent of payroll.
The expansion in coverage will be paid for by trimming $400 billion in Medicare spending over the next decade, and by imposing a 5.4 percent tax surcharge on all individuals earning more than $500,000 and families earning more than $1 million.
The House bill also includes language that strongly restricts the use of public funds for abortion – a last-minute compromise struck late Friday night to gain the votes of dozens of anti-abortion Democrats.
Under the abortion language, offered as an amendment by Rep. Bart Stupak, D-Mich., the public insurance plan will not be able to offer abortion services, and no one who receives a government subsidy to purchase insurance will be able to use that money to buy a plan that covers abortion services.
The Stupak amendment passed 240-194 in separate vote before the main vote on the legislation Saturday, with the support of 64 Democrats and 176 Republicans.
Many pro-choice Democrats were upset with the last minute deal. Rep. Diana DeGette, D-Colo., called the amendment “the biggest restriction on a women’s right to chose that’s been considered on the floor of the House,” in her 13 years in Congress, according to the New York Times.
But many pro-choice Democrats reasoned that it was worth the cost to pass the overall bill.
Rep. Jan Schakowsky, D-Ill., one of those Democrats, described on the House floor other benefits women would receive from passing health care reform legislation. “Women need health care reform,” she said, according to ABCnews.com.
Even with the hurdle of a House vote cleared, the legislation still faces a long road ahead. In the Senate, Majority Leader Harry Reid, D-Nev., has indicated that the Senate may not vote on health reform legislation before the White House’s Christmas deadline.