Breaking News - House passes second historic health care vote

The aftermath of the great Washington health care debate has held true to form, breaking down strictly down partisan lines. House Democrats hailed their final vote on health care reform tonight as a historic breakthrough, ending more than 70 years of efforts to put all Americans under some form of health care coverage. Republicans just as forcefully denounced today's vote - which approved both the original Senate bill and some key "fixes" to it - as an irresponsible and needless expansion of big government amid ballooning federal deficits.


The bill passed 220 to 211.

Tonight's second vote was designed to rid the final legislation of some of the more-controversial provisions in the Senate version of the bill, such as the special multimillion-dollar increases in Medicaid for the states of Nebraska and Louisiana, which were instrumental to winning the support of wavering Sens. Mary Landrieu (D-LA) and Ben Nelson (D-NE). The vote also closes up the "doughnut hole" in the Medicare prescription drug benefit, which leaves seniors without drug subsidies for several months - which has likewise proved critical in winning the backing of the pharmaceutical industry and has been blanketing the airwaves with ads urging passage of the bill.

While the Senate still has to weigh in on the amended bill, most observers think that shouldn't be much more than a formality, especially at this late stage of the process. At the very least, the House vote ensures that there will be a health care bill on President Obama's desk, perhaps as early as the end of this week. And the president's signature will set into motion the most dramatic change to American health care since Lyndon Johnson signed Medicare into law in 1965.

The bill, which the Congressional Budget Office says will cost $940-billion over ten years, is expected to cover an estimated 32 million Americans who are presently uninsured. Among its major provisions:

-An "individual mandate" will require all Americans to purchase some form of health care coverage, with government subsidies provided to those needing financial assistance to do so. People who don't obtain coverage of some sort will be subject to federal fines, which would begin to take effect in 2015.

-All employers with 50 or more employees will be legally obliged to offer coverage - or else they will be assessed a stiff fine of $2,000 per uninsured employee.

-Insurance exchanges - that is, purchasing pools for individuals not covered by employer-provided or federal plans such as Medicare - will be able to obtain coverage.

-Private insurers will no longer be permitted to deny coverage or raise premiums on the basis of pre-existing medical conditions or illness.

-Cost controls will be phased in via expanded coverage plans, resulting in a $1.3 trillion reduction in the federal deficit during the next 20 years, against $940 billion in costs associated with the bill, according to estimates from the Congressional Budget Office.