US Congress passes historic health overhaul

The US Congress passed an historic health care overhaul late Sunday, handing President Barack Obama a landmark win and taking the United States closer than ever to guaranteed coverage for all Americans.

The Democratic-held House of Representatives voted 219-212 to approve a Senate-passed bill aimed at extending coverage to 32 million Americans who currently lack it in the most sweeping social policy shift in four decades.

"Tonight we answered the call of history as so many Americans have before us. We did not avoid our responsibility we embraced it. We did not fear our future, we shaped it," Obama said in brief remarks shortly after the vote.

The president, who was expected to sign the bill into law within days, praised lawmakers for defying the predictions of pundits that the mammoth bill must collapse in the face of political setbacks and unyielding partisan rifts.

Tired after a week in which he met or spoke to nearly 100 lawmakers, but evidently savoring a hard-fought triumph on his top domestic goal, Obama told the US public: "This is what change looks like."

As the vote count crept past the 216 needed to ensure passage, Democrats clapped, cheered, hugged, high-fived, and called out Obama's "Yes, we can" 2008 campaign slogan.

All 178 Republicans and 34 conservative Democrats opposed the measure, spurred on by hundreds of protesters who chanted "Kill the bill" during a loud day-long vigil outside the Capitol.

With Vice President Joe Biden at his side, Obama acknowledged Republican warnings that Democrats would pay a steep political price in November mid-term elections that will decide control of the US Congress.

"I know this wasn't an easy vote for a lot of people. But it was the right vote," said the president, who has vowed to help Democrats in swing districts win reelection.

The Senate was now to take up a free-standing packages of changes, which the House approved 220-211, as early as Tuesday in a bid to complete its work on the overhaul.

Together, the Senate bill and changes would remake US health care a century after then-president Teddy Roosevelt called for a national approach, extending coverage to 95 percent of the under-65 population.

The bill bans insurance company practices like denying care for preexisting conditions, imposing lifetime caps on coverage, while providing subsidies to buy private insurance in newly-created marketplaces called "exchanges."

It also raises some taxes on the wealthy while expanding a government-run program for needy Americans.

"This bill is complicated, but it's also very simple: Illness and infirmity are universal, and we are stronger against them together than we are alone," Democratic House Majority Leader Steny Hoyer said before the vote.

"This trillion-dollar overhaul will take the America we know and love in the wrong direction," said Representative Eric Cantor, the number two House Republican, who noted 34 Democrats joined all 178 Republicans in voting "no."

Republicans also vowed to keep up the fight in the Senate -- the next battleground -- and repeal the broadly unpopular bill if they win back majorities in November.

After a year of often bitter debate, Obama cleared the way to his victory with an 11th-hour deal to sign an executive order reaffirming a longstanding US ban on government funding for abortions, winning support for the bill from a group of conservative Democratic holdouts.

"I've always supported health care reform," said the group's leader, Democratic Representative Bart Stupak, flanked by other anti-abortion lawmakers. "This bill is going to go through."

The Senate was expected this week to take up the changes and approve them separately, under rules that prevent Republicans from using a parliamentary tactic, the filibuster, to indefinitely delay and therefore kill the measure.

Senate Republican Minority Leader Mitch McConnell said Republicans "will now do everything in our power" to fight the bill, while another top Republican described plans to besiege the legislation with "hundreds of amendments."

Opinion polls have painted a confusing picture, with respondents expressing strong support for individual elements of the bill, but with large numbers saying they oppose the overall measure.

Democrats have highlighted the independent Congressional Budget Office's estimate that the bill would cost 940 billion dollars over the next 10 years, while cutting 143 billion dollars from the bloated US deficit through 2019 and 1.2 trillion over the following decade.

What's at stake in the health care reform bill

The United States drastically outspends other countries on health care, yet has worse overall outcomes and leaves millions at risk of losing their homes or even lives for lack of insurance.

Championed by President Barack Obama and villified by Republicans, the health care reform bill that passed the Congress Sunday extends insurance to 95 percent of Americans by covering an additional 32 million people and rein in spiraling costs.

Here are some facts about the existing state of the health care system which has been described as "an administrative monstrosity."

-The United States is the only major industrialized nation which does not offer some form of universal health care. The government does provide coverage to the elderly and disabled under Medicare, some of the very poor under Medicaid, government workers and military veterans.

-Some 15.4 percent of the US population - or 46.3 million people - did not have health insurance in 2008, according to the Census Bureau. Since about 10 million of those are not US citizens, the most commonly cited number is 36 million people.

-Nearly 45,000 people die every year in the United States because they don't have health insurance, a recent study by Harvard University researchers found.

-Premiums for health insurance provided by employers have doubled since 2000 and most workers are spending more out of pocket even as the services covered shrink.

-Medical bills contribute to more than half of personal bankruptcies and homes lost to foreclosure.

-Until now, insurance companies have been able to deny or even revoke coverage for pre-existing conditions like heart disease, cancer or - in nine states - injuries sustained from domestic violence.

-Total health care spending accounted for 2.2 trillion dollars in 2007, or 16.2 percent of US GDP. That's five percentage points more than second-ranking France and nearly twice the proportion spent by the United Kingdom and Japan.

-Per capita spending in the United States also ranks far ahead of other industrialized nations at 7,290 dollars in 2007. That's more than 2,500 dollars more per person than Norway, which ranks second, and about 2.5 times the OECD average of 2,984 dollars per person.

Main points of Obama health care plan

President Barack Obama's health care bill, which passed Sunday in the House of Representatives, aims to bring the United States closer to universal coverage than ever before.

The plan is intended to usher in the most sweeping overhaul of its kind in four decades and extend coverage to some 32 million Americans out of the 36 million who lack it now, according to the independent Congressional Budget Office (CBO).

The legislation carries an initial 10-year price tag of 940 billion dollars, but would reduce the ballooning US deficit by 138 billion dollars through 2019 and 1.2 trillion over the following decade, the CBO said.

Here are some other notable features of the compromise, which requires the House to pass the Senate's health bill, followed by both chambers approving a package of changes to make the overhaul more palatable to the lower chamber.

- Tough new rules on private insurers:

The bill would ban insurance company practices like denying coverage for preexisting illnesses, dropping people from coverage when they get sick, or capping lifetime coverage, and restrict new plans' use of annual limits.

- No "public option"

After a year-long fight, Obama's Democratic allies opted not to include a government-backed program to compete with private insurers, which supporters and many analysts described as the best way to rein in costs.

- New insurance markets

Instead, the plan creates new state-based marketplaces called exchanges where Americans without employer-provided coverage could buy insurance.

- Requirements, subsidies

For the first time in US history, most Americans would be required to buy insurance or face fines, and larger firms could face penalties for not offering coverage.

But the bill would also offer subsidies to help individuals who earn too much to get coverage under an expansion of the government's Medicaid program but under 400 percent of the US federal poverty level, which in 2009 stood at earnings of 22,000 dollars per year for a family of four.

- Elderly drug benefits

The bill offers a rebate to seniors who fall into a "donut hole" gap in prescription drug coverage under the government-run Medicare program for the elderly. The gap would be phased out by 2020.

Battle for US health care reform has long history

The battle to remake US health insurance, which took a giant step forward Sunday when lawmakers passed key reform legislation, has long been a stumbling block for US presidents.

1912: Then-president Theodore Roosevelt, who supports health insurance policies inspired by the reforms carried out 40 years earlier in Germany by Otto Von Bismarck, is defeated by his rival Woodrow Wilson.

1933 -- Roosevelt's nephew, Franklin Delano Roosevelt unveils the "New Deal," designed to carry the country out of the 1929 depression, which includes a health care system. But the health reforms are attacked by the medical profession and never make it into legislation.

1945 -- FDR's successor Harry Truman proposes mandatory health insurance, a suggestion that fails to gain traction in Congress.

1962 -- President John F. Kennedy calls for health insurance for the elderly, another proposal that fails to pass Congress.

1965 -- Lyndon Johnson finally manages to create two new health care programs. Medicaid is created to cover health costs for the poor and those with disabilities, while Medicare covers Americans over the age of 65. Today, more than 100 million people are covered by one of the two programs.

1976 -- Jimmy Carter campaigns for universal health care, but is forced to scrap the idea amid grim economic circumstances.

1989 -- Congress abolishes a law that had been adopted just 18 months earlier with the support of then-president Ronald Reagan to allow the elderly to escape "catastrophic" costs associated with serious illness.

1994 -- A universal health care plan supported by then-president Bill Clinton and championed by his wife Hillary Clinton fails to pass Congress.

2010 -- Congress passes legislation supported by President Barack Obama that will extend health insurance to over 30 million uninsured Americans. The plan fails to include a government-administered "public option," but does include help and sanctions included to ensure nearly all Americans will purchase health care.

-Health care spending is expected to eat up 25 percent of the US economy by 2025, according to the Congressional Budget Office.

-While the United States excels in areas such as cancer care, it lags behind other industrialized nations in avoidable hospital admissions for treatable conditions like asthma and diabetes, the OECD found. Disparities also lead to high infant mortality rates and a shortened life expectancy.

(c) 2010 AFP