Democrats gird for next step in health care fight

WASHINGTON (AFP) - – Democrats braced for the next battle in pushing the most sweeping US health care overhaul in a half-century through Congress, after handing President Barack Obama victory in a narrow House vote.

After 12 hours of bitter debate, the bill squeaked through the US House of Representatives by 220 votes to 215 in a rare late Saturday session after President Barack Obama appealed to lawmakers to "answer the call of history."

But only one Republican broke ranks to back the bill which amounts to a 10-year, trillion-dollar plan to extend health coverage to some 36 million uninsured Americans.

The action now shifts to the 100-seat Senate where the fate of its own version remains unclear, with Democrats needing all their 60 senators to come on board to have a hope of passing the legislation.

"The House bill is dead on arrival in the Senate. Just look at how it passed," said Republican Senator Lindsey Graham, signaling the tough fight ahead.

"You had 40 -- 39 Democrats vote against the bill. They come from red states, moderate Democrats from swing districts. They bailed out on this bill. It was a bill written by liberals for liberals," he told CBS television.

Obama, who was set to make another statement on the issue at 1800 GMT Sunday, had hailed the vote late Saturday.

"Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people," Obama said in a statement.

Obama said he was "absolutely confident" the Senate would pass its own bill, adding he looked forward to signing it into law by the end of the year.

But Democratic Senate Majority Leader Harry Reid signaled last week that intra-party divisions mean the timetable could slip to 2010.

"We're not going to be bound by any timelines. We need to do the best job we can for the American people," said Reid, who needs 60 votes to ensure he can overcome parliamentary delaying tactics.

House Speaker Nancy Pelosi said the bill "improves quality, lowers cost, expands coverage to 36 million more people and retains choice."

But Republican Minority Leader John Boehner said it amounts to a government takeover of the health care industry "that increases costs, adds to our skyrocketing debt" and "destroys jobs with tax hikes and new mandates."

If, as expected, the House and Senate pass rival versions of health care legislation, they will need to thrash out a compromise bill and approve it before sending it to Obama to sign into law.

Obama and Democratic House leaders had invested heavy political capital in what they knew would be a close contest sure.

The president telephoned wavering members on Friday and paid a rare visit to Congress on Saturday, but still 39 Democrats joined 176 Republicans to oppose the plan.

One Republican -- Joseph Cao of Louisiana -- broke ranks, nominally fulfilling, in the barest terms, Obama's vow to secure bipartisan support.

The Vietnamese-American, who represents a heavily Democratic district, Sunday defended his vote as the right decision for his constituents.

"I made the vote to support the health care reform bill because a lot of my constituents are uninsured, a lot of them are poor and it was the right decision for the people of my district," Cao told CNN.

The chamber's Democrats erupted in loud cheers and applause the moment the bill had the 218 votes needed for passage, about 11:07 pm (0407 GMT).

Final House passage came after a flurry of votes, including a 240-194 vote to sharply tighten restrictions on government funds for abortions, vital to bringing on board anti-abortion Democrats.

The United States is the only industrialized democracy that does not ensure that all of its citizens have health care coverage.

Under the White House-backed bill, all Americans would have to buy insurance and most employers would have to offer coverage to their workers -- though some small businesses would be exempt and the government would offer subsidies.

Washington spends vastly more on health care -- both per person and as a share of national income as measured by gross domestic product -- than other industrialized democracies, but with no meaningful edge in quality of care.

The bill would create a government-backed insurance plan, popularly known as a "public option," to compete with private firms and would stop companies denying coverage due to pre-existing medical problems.