Democrats in the House of Representatives achieve a legislative landmark that has eluded generations of lawmakers before them. House passes landmark health bill

Democrats in the House of Representatives achieved a legislative landmark Sunday night that has eluded generations of lawmakers before them – reshaping the American health care system to extend insurance coverage to nearly 32 million people and halt industry practices that discriminate against the sick.

Sunday’s House vote on a Senate reform plan represents the climatic finale to a yearlong saga that has taken its toll on the president and his party – one that had dimmed Barack Obama’s once-incandescent star and now sets up an uncertain postscript for his Democratic colleagues headed for reelection fights in the fall.


The 219-212 vote, with no Republicans voting yes and 34 Democrats voting no, nonetheless secures a historic win for Obama while providing his party with some much-needed momentum after a long, grueling slog that has Democrats playing defense in the run-up to the midterm elections.

“This isn’t radical reform, but it is major reform,” Obama said shortly before midnight at the White House. Referring back to his own presidential campaign slogan, Obama said, “This is what change looks like.”

Obama watched the vote in the Roosevelt Room with Vice President Joe Biden and about 40 staffers – who burst into cheers when the vote count hit the 216-vote mark, meaning the bill was on its way to Obama’s desk and into law.

The president is likely to sign the bill Tuesday, then set off on a new campaign of selling it all over again to a deeply skeptical public. Republicans already are threatening a variety of legislative and legal challenges to the bill.

Emotions ran high on the House floor, and someone from the Republican side of the chamber shouted “Baby killer!” at Michigan Rep. Bart Stupak – a staunch opponent of abortion – as he spoke against a Republican motion to kill the reform bill.

Stupak is the leader of a group of a half-dozen anti-abortion Democrats who cut a deal with the White House that cleared the way for final passage on the bill Sunday. It wasn’t clear who shouted, but reporters and at least one GOP lawmaker said it seemed to come from a Republican House member, who couldn’t be identified Sunday night.

House Speaker Nancy Pelosi invoked the late Sen. Ted Kennedy in urging her colleagues to vote yes, reading from a letter that Kennedy left to be read by Obama after Kennedy’s death last year. "Senator Kennedy wrote that access to health care was the great unfinished business of our society – that is, until today," said Pelosi.

She spoke in historic terms of the $938 billion bill, comparing it to landmark legislation like Social Security and Medicare – reforms that changed the social fabric of the nation and Americans’ fundamental relationship with their government.

The bill represents the biggest expansion of government-funded health care since the creation of Medicare. The legislation requires all Americans to secure insurance coverage, either through their jobs or through a state-run insurance exchange that goes into effect in 2014, and provides subsidies for those who can’t afford it. The reforms mean 95 percent of all documented Americans will have coverage by 2016, according to the Congressional Budget Office.

Also on Sunday night, the House passed a “clean-up” bill to make fixes to the Senate legislation, by a vote of 220-211. Then later this week, possibly as early as Tuesday, the Senate will take up that bill as well – but only after the president signs the underlying bill into law.

A weekend of protests by conservative activists outside the Capitol brought home the high political stakes surrounding the vote, as Republicans have vowed to try to dislodge the Democratic majorities in the House and Senate by convincing Americans reform is a costly and dangerous government overreach. Democrats believed – or hoped at least – that by putting the messy process of enactment behind them, they could make the case to the public that there is much to be gained from reform.

From the outset of the debate, Republicans favored a scaled-back approach that focused on lowering premiums for people who have coverage instead of expanding it to those who don’t. On Sunday, GOP lawmakers said the near-trillion dollar package threatened to bankrupt the government.

“This is not who we are, and it is not who we should become,” said Wisconsin Rep. Paul Ryan. “It’s unconscionable what we’re leaving the next generation.”

House Republican leader John Boehner (R-Ohio) turned to his Democratic colleagues across the aisle. “Have you read the bill? Have you read the reconciliation bill? Have you read the manager’s amendment?” Boehner said, as Democrats shouted back “yes!” each time.

“Hell no you haven’t!” Boehner thundered, as the chair gaveled him down.

At midnight, about an hour after the first vote, some Democratic lawmakers returned to a spot outside the Capitol where conservative Tea Party protestors has shouted at them over the past two days. The Democrats were cheering and thanking anyone who came by.

New York Rep. Anthony Weiner shook hands with supporters. Connecticut Rep. John Larson walked by, clutching the bill. And Georgia Rep. John Lewis, who was active in the civil rights movement, received a hero's welcome.

"It feels good, it feels good. It feels so good to win one," Lewis said.

The legislation has been at death’s door almost from the moment it was introduced, revived again and again by a persistent president and a core of devoted advocates on Capitol Hill. But each reincarnation sparked another round of infighting among Democrats about what the final bill should look like.

Once again, the final vote came down to a decades-old interparty fight over abortion – and Stupak.

But Democrats owe their greatest debt to vulnerable colleagues who backed the bill, even though it could easily cost them their seats come the fall – members like Pennsylvania Rep. Kathy Dahlkemper, Ohio Rep. Steve Driehaus and Virginia Rep. Tom Perriello.

"Who are you going to stand with?" declared Ohio Democratic Rep. John Boccieri, a last-minute convert to “yes” who opposed the bill when the House first voted in November.

The buildup to Sunday's long-awaited vote lacked the drama of its predecessor, a nail-biter last November in which Democrats corralled the final votes shortly before heading to the floor.

Instead, a deal anti-abortion Democrats cut with the White House late Saturday night paved the way to passage on Sunday. After a late-night session with the president’s advisers, Stupak and others agreed to support the legislation in exchange for an executive order from the president reaffirming the longstanding ban on federal funding of elective abortion.

Stupak also forced party leaders to articulate that promise on the House floor, making it a part of the federal record. He engaged in that exchange with Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), a principal author of the legislation who has locked horns with the Michigan Democrat repeatedly.

The deal came about after a personal appeal from Stupak’s longtime ally, fellow Michigan Rep. John Dingell, the former chairman of the House Energy and Commerce Committee whose father first offered legislation creating universal health care back in 1943. Dingell helped broker negotiations between an angry Stupak and party leaders at both ends of Pennsylvania Avenue when all looked lost.

"John Dingell had a piece of me yesterday for quite some time," Stupak said. "He kept me well informed of what I should be doing."

Stupak stole all the early headlines, but Pennsylvania Rep. Mike Doyle and some other lawmakers helped broker a truce with the White House and abortion-rights advocates, led by Connecticut Rep. Rosa DeLauro. Stupak, though, gave them all the political cover they needed to back the final package.

Democrats built momentum all week, and Sunday was no different. As news of the Stupak deal filtered out, Washington Rep. Brian Baird, who voted against the House bill, kicked off the day by announcing his plans to vote "yes" this time. North Dakota Rep. Earl Pomeroy, another wavering Democrat, followed that up by announcing his plans to back the bill, despite numerous reservations with the legislation and the final process.

The combined legislation expands Medicaid by $434 billion over the next decade so that people who make less than 133 percent of poverty are covered in every state, the CBO said. It also sets aside $466 billion in subsidies to help lower- and middle-income households that don’t qualify for Medicaid buy insurance on the exchange. The Senate bill also imposes fees on companies that don't provide coverage to their employees and sets penalties for people who don't participate.

The House “fix-up” bill makes changes that make the Senate legislation more palatable to House Democrats -- including rolling back a tax on high-cost insurance plans to 2018 and cutting out the “Cornhusker Kickback” and other special deals.

Lost in all the drama over health care, the reconciliation fix also includes a dramatic revamp of the student-lending industry that would shift billions in federal aid from private lenders back to the government.

The president’s health care push touched off angry protests from Americans worried about the costs of the legislation, its impact on the economy and whether it would be a government intrusion on the doctor-patient relationship. Sunday was no different. On the Capitol grounds, opponents and supporters of the bill showered the building in chants. Thousands of protestors gathered on the lawn beneath the House chamber chanting, “Kill the bill! Kill the bill! Kill the bill!” Republicans, on a balcony overhead, took turns rallying the crowd by waving an American flag.

The protests at times turned ugly. After Lewis was called a racial epithet on Saturday, Pelosi and Democratic leaders locked arms with Lewis to cross the Capitol complex Sunday, brandishing the gavel used to pass Medicare.

The win enhances Pelosi’s stature as a historic figure, not just as the first female speaker in House history but also as one of its most powerful. Colleagues credit her resolve for keeping the process alive after a catastrophic special-election result for the party in Massachusetts erased its commanding 60-vote supermajority in the Senate.

But even with the votes seemingly in hand, Pelosi never stopped working.

During a round a votes Sunday, a Republican aide overheard Illinois Rep. Jerry Costello, an anti-abortion Democrats who was still holding out after the Stupak deal, tell the speaker, "I will not be intimidated."

Speaker Nancy Pelosi just buttonholed Rep. Ike Skelton, chairman of the Armed Services Committee, who has remained a "no" vote, in the speaker's lobby off the floor for a few minutes.

As she wrapped up her private talk and headed back to the floor, Rep. Charlie Rangel (D-N.Y.) was anxious to find out what happened.

"Did he change? Did he change?" Rangel asked.

"No, but I'll talk to you," Pelosi said, pointing to the floor.

Skelton, meanwhile, disappeared.

Retiring Rhode Island Rep. Patrick Kennedy, referring to his late father, Ted Kennedy, said, “No memorial oration or eulogy could more eloquently honor his memory than the earliest possible passage of this bill for which he fought so long. . . His heart and his soul are in this bill.”

Sunday's vote, said House Majority Leader Steny Hoyer (D-Md.), "concludes a national conversation that began more than a century ago."

Carol E. Lee, Jonathan Allen, David Rogers, Carrie Budoff Brown and James Hohmann contributed to this report.