Hailing the overnight vote, President Obama said: “After decades of trying, and a year of sustained effort and debate, the United States Congress finally declared that America's workers and America's families and America's small businesses deserve the security of knowing that here, in this country, neither illness nor accident should endanger the dreams they've worked a lifetime to achieve.”

He said they had proved pundits wrong, rose above politics and poll numbers and resisted “special interests” and did not give in cynicism or fear. “ Instead, we proved that we are capable of doing big things” and that “this government of the people and by the people, still works for the people“.

Health care reform - to make it affordable and extend coverage to the uninsured - was Mr. Obama's dominant electoral theme but success had eluded him to make it his big achievement in his first year in White House. Democrats in both Houses, wrangling over details, the President again took the debate across the nation before he rallied his partymen for the final push.

Mr. Obama's popular rating also suffered in recent months as he seemed excessively preoccupied with this reform to the exclusion of other priorities beyond his concerted moves to lift the 14-trillion dollar economy out of its worst recession since the Great Depression (1930s). Still, overhauling the nation's “broken” health care system has become a trademark achievement which many of his predecessors had sought in vain for more than half a century.

The House legislation, approved after a tumultous debate on a Sunday, embodies the Senate version which was adopted on December 24, to extend coverage to millions of uninsured Americans, bring down costs for low and middle income people and small businesses, and bar insurance companies from denying access due to pre-existing medical conditions. This bill, now going to the President, would soon become the law of the land, the White House said.

The House was later due to pass a separate measure to make significant changes and additions to the Senate bill and these would go back to Senate where Democrats are assured of votes to pass them. The reformed health care system would cost 938 billion dollars over a ten-year period but it would not impact on Federal finances with costs paid for by levies and savings.

Democrats were jubilant over the outcome which they noted was as historic as the social security created nearly five decades ago and which would arrest the skyrocketing costs of health care at present and rein in deficits over the longer term. “This is the civil rights act of the 21st century”, one Democrat said. Till the last moment there was doubt over putting together the needed 216 votes for Democrats to get the measure through, despite the confidence derived from the first procedural vote to take up the legislation by 224-206.

This was because of a section against the use of Federal funds for abortions. Before the final vote, the White House announced that the President would issue an executive order after the passage of the health insurance reform law that will “reaffirm its consistency with longstanding restrictions on the use of federal funds for abortion'.

Republicans had galvanised themselves and their supporters with a campaign to “kill the bill” and they contended that the bill now being passed into law would add massively to pubic debt and amount to a Federal take-over of health. There were protest demonstrations outside the Capitol Hill against the passage of the bill while supporters had also gathered to cheer passage.

Democrats had been highly encouraged by the non-partisan Congressional Budget Office (CBO) report that the nearly trillion dollar bill (938 billion), with additions to the Senate version of 875 billion, would result in deficit reduction of 138 billion over the first decade and substantially up to 1.2 trillion dollars in the next decade, no matter such long-term projections could be somewhat speculative. The White House Budget Office Director Mr. Peter Orszag said the “historic, fiscally responsible health insurance reform” would give “more choice and security to those with health insurance, provide access to coverage to those without (at least 32 million), improve the quality of health care for us all, and provide the most deficit reduction of any bill in over a decade“.

The bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls (for low-income) and would subsidise private coverage for low- and middle-income people, at a cost to the government of $938 billion over 10 years, according to CBO. It would require many employers to offer coverage to their employees or pay a penalty. Each state would set up a marketplace, or exchange, where consumers without such coverage could shop for insurance meeting federal standards.

Though the bill would provide coverage to 32 million uninsured people, it would still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants. The new costs, according to the budget office, would be more than offset by savings in Medicare and by new taxes and fees, including a tax on high-cost employer-sponsored health plans and a tax on the investment income of the most affluent Americans. Mr. Orszag said the legislation would represent the most important deficit reduction package that would be enacted in over a decade—and, perhaps more importantly, represents “the first serious piece of legislation that would begin the process of addressing our long-term fiscal imbalance by re-orienting the health system toward quality rather than quantity“.

Countering the Republican cynical disregard of President Obama's sustained efforts for bipartisanship, the White House has established a bipartisan Finance Commission to come up with recommendations on how to lower the country's trillion dollar deficits and soaring debt over the long haul. The Commission's report would be made available towards the end of 2010 after the midterm Congressional elections in November.

Following the unexpected loss of the Senate seat from Massachusetts held by the Kennedy family for fifty years until the death of Senator Edward Kennedy last year, Democrats, mindful of constituency factors on every issue, are besieged by electoral uncertainties. Republicans see them demoralised and have stepped up their campaign in the hope of returning with a majority in the November elections.

House Speaker Nancy Pelosi, leading the Democrats, noted the historic bill would free people 'to pursue their dreams without having to worry about being bankrupted by medical bills or losing health insurance when they switch jobs'. It is a 'liberating legislation' she added. President Obama profusely thanked Speaker Nancy Pelosi for her “extraordinary leadership“ and other Democrat leaders for their commitment to getting the job done. (IPA Service)