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Democrats hail landmark US healthcare bill

Speaker of the House Nancy Pelosi (D-CA) (C) delivers remarks during a press conference with (L-R) House Majority Leader Steny Hoyer (D-MD), Rep. George Miller (D-CA), Majority Whip Rep. James Clyburn (D-SC) and Rep. John Larson (D-CT) (R)
Democrats hope that once the voters see the law taking effect they will like it

Democrats have hailed the approval of legislation extending healthcare to an additional 32 million Americans as a historic advance in social justice.

The speaker of the House of Representatives, Nancy Pelosi said it was comparable to the establishment of Medicare and Social Security.

The bill was passed in the House on Sunday evening by just seven votes.

Republicans have vowed to continue to challenge it, saying it is too expensive and promotes big government.

Senator John McCain, the defeated presidential candidate, warned that outside the capital "the American people are very angry".

"They don't like it, and we're going to repeal this," he told ABC News.

President Barack Obama is expected to sign the bill as early as Tuesday, after which it will go to the Senate where Democrats hope it will be passed by a simple majority under budget reconciliation.

'New day in America'

The BBC's Adam Brookes in Washington says Mr Obama's long, stubborn effort to reform healthcare came to fruition after a dramatic late night in Congress.

We have failed to listen to America... This body moves forward against their will. Shame on us
Rep John Boehner
House Republican leader

The House approved the bill passed by the Senate on Christmas Eve by 219 votes to 212, with 34 Democrats joining Republicans in voting against it.

Victory was assured only hours before voting started, when the president agreed to a deal with conservative Democrats to reiterate in an executive order that money provided by the bill could not be used for abortions.

Democrats were jubilant after the vote, with House Majority Whip Representative James Clyburn describing it as "Civil Rights Act of the 21st Century".

Rep Marcy Kaptur of Ohio said the bill heralded "a new day in America", while Rep Doris Matsui of California said it would "improve the quality of life for millions of American families."

President Barack Obama: 'It's a victory for the American people'

The president said that after nearly 100 years of debate and frustration, Americans finally had the assurance of universal health cover.

"We pushed back on the undue influence of special interests," he said in a statement. "We didn't give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things."

"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction," he added.

Under the plans, health insurance will be extended to nearly all Americans, new taxes will be imposed on the wealthy, and restrictive insurance practices such as refusing to cover people with pre-existing medical conditions will be outlawed.

ANALYSIS
Mark Mardell
Mark Mardell, BBC News, Washington

While many Americans seem to genuinely yearn for the cross-party accord they call bipartisanship, and politicians at least play it pious lip service, this lengthy debate has revealed a gaping ideological chasm.

President Obama identified overhauling the healthcare system as his priority and he's got what he wanted, a victory that eluded Teddy Roosevelt, Richard Nixon and Bill Clinton. But when he threw down the gauntlet the conservatives eagerly picked it up. Healthcare didn't create the tea party movement but it gave it a focus and a cause.

There are dangers to his left as well as his right. He's harmed his reputation with his own power base, for many liberals feel there have been so many compromises the bill is hardly worth it.

The House Republican leader, Rep John Boehner, said lawmakers had defied the wishes of their constituents.

"We have failed to listen to America," he added. "This body moves forward against their will. Shame on us."

Our correspondent says many Americans do seem bemused by the size and complexity of the bill and have been angered by the long, bitter process of its passage.

The New York Times, which has supported the reforms, called the vote an accomplishment of historic proportions, but the Wall Street Journal said the bill would mean much higher taxes, slower economic growth and worse medical care.

Democrats hope that once the voters see the new law taking effect they will learn to like it before they go to the polls in mid-term elections in November, our correspondent adds.

'Fixes'

The bill's final approval represented a stunning turnaround from January, when it was considered dead after Democrats lost their 60-seat majority in the Senate, which is required to defeat a filibuster, a method used to delay or block the passage of legislation.

KEY HEALTHCARE REFORMS
Cost: $940bn over 10 years; would reduce deficit by $143bn
Coverage: Expanded to 32m currently uninsured Americans
Medicare: Prescription drug coverage gap closed; affected over-65s receive rebate and discount on brand name drugs
Medicaid: Expanded to include families under 65 with gross income of up to 133% of federal poverty level and childless adults
Insurance reforms: Insurers can no longer deny coverage to those with pre-existing conditions
Insurance exchanges: Uninsured and self-employed able to purchase insurance through state-based exchanges
Subsidies: Low-income individuals and families wanting to purchase own health insurance eligible for subsidies
Individual Mandate: Those not covered by Medicaid or Medicare must be insured or face fine
High-cost insurance: Employers offering workers pricier plans subject to tax on excess premium

To avoid a second Senate vote, the House also approved on Sunday evening a package of reconciliation "fixes" - agreed beforehand between House and Senate Democrats and the White House - amending the bill that senators adopted in December.

The president could sign the House-approved Senate bill as early as Tuesday, after which it will be officially enacted into law. However, the bill will contain some very unpopular measures that Democratic senators have agreed to amend.

The Senate will be able to make the required changes in a separate bill using a procedure known as reconciliation, which allows budget provisions to be approved with 51 votes - rather than the 60 needed to overcome blocking tactics.

The Republicans say they will seek to repeal the measure, challenge its constitutionality and co-ordinate efforts in state legislatures to block its implementation.

The White House plans to launch a campaign this week to persuade sceptical Americans that the reforms offer immediate benefits to them and represent the most significant effort to reduce the federal deficit since the 1990s.

According to the Congressional Budget Office, the healthcare bill will cost about $940bn (£626bn over 10 years, and will cut the federal deficit by $143bn (£92bn) over the same period.

US HEALTHCARE AND WORLD COMPARISONS

Map showing highest snowfall and lowest temperature
Healthcare reform is a priority for Barack Obama. The US spends about $2.2tn a year on its system - which includes private, federal or employer schemes.
1 in 10 people missed work on Monday and Tuesday
US expenditure on healthcare is the equivalent of about 16.2% of GDP - nearly twice that of some other OECD countries.
Graphic showing amount of grit used so far
The US falls behind some OECD countries for life expectancy and has a higher rate of infant mortality. Almost 46m US citizens do not have health insurance.
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