By Adamy & Bendavid, Wall Street Journal - November 8, 2009

Hours after President Obama exhorted Democratic lawmakers to "answer the call of history," the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.

After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote that included 39 defections, mostly from the party's conservative ranks. But the bill attracted a surprise Republican convert: Rep. Anh "Joseph" Cao of Louisiana, who represents the Democratic-leaning district of New Orleans and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.

Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage. Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry M. Reid (D-Nev.) hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama's desk before the new year.

At the Capitol, Obama urged the few Democrats who were still wavering on Saturday afternoon to put aside their political fears and embrace the bill's ambitious objectives. "Opportunities like this come around maybe once in a generation," he said afterward. "This is our moment to live up to the trust that the American people have placed in us. Even when it's hard. Especially when it's hard. This is our moment to deliver."

The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.

Though some people would receive no benefits -- including about 6 million illegal immigrants, according to congressional estimates -- the bill would virtually close the coverage gap for people who do not have access to health-care coverage through their jobs.

"For generations, the American people have called for affordable, quality health care for their families," House Speaker Nancy Pelosi (D-Calif.) said before the vote. "Today, the call will be answered."

The debate on the House floor extended for about 12 hours and settled into a civil, if predictable, pattern, after a heated start.

Republicans had blasted the 1,990-page bill as an ominous blueprint for a budget-busting government takeover of the private health-care system that would impose unprecedented mandates on individuals and employers, raise an array of taxes and slash projected spending on Medicare, the federal health program for the elderly. At a time of record budget deficits, Republicans argued that the country could ill-afford a new entitlement program that would cost an estimated $1.05 trillion over the next decade.

"Big government doesn't mean better health care," said Rep. Kevin Brady (R-Tex.). "This is not the reform families need. This is all about taking a giant first step toward a single-payer national health-care system. Washington will ultimately decide what doctors you can see, what treatments you deserve . . . and, when you're sick, will you be worth their cost?"

Throughout the debate, Republican after Republican warned that the legislation would rob Americans of their right to make choices about their health care, cost the nation jobs and unfairly financially burden future generations.

Pelosi needed to corral at least 218 of 258 Democrats to push the bill across the finish line. That task appeared to grow easier after party leaders broke a weeks-long impasse over abortion by agreeing to hold a vote on an amendment -- offered by antiabortion Democrats -- that would explicitly bar the public plan from` covering the procedure. The amendment, approved 240 to 194, with 64 Democrats in favor, also would prohibit people who received insurance subsidies from purchasing private plans that covered abortion.