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The House passed its $1 trillion healthcare overhaul late Saturday with only two votes to spare, becoming the first chamber to vote on such a significant expansion of healthcare since Congress passed Medicare in 1965.

The 220-215 vote late Saturday was a victory for House Speaker Nancy Pelosi and President Barack Obama, who came to Capitol Hill to rally his fellow Democrats in the hours before the vote.

One Republican, Joseph Cao (R-La.), voted for the bill, and 39 Democrats bucked their party's leaders to vote no. But final passage was assured by a late-night agreement Friday to give abortion opponents a vote on an amendment preventing any of the subsidies in the bill from paying for abortion. The amendment passed, giving a margin of comfort to anti-abortion Democrats, but angering abortion-rights supporters.

The bill includes a requirement for individuals to have health insurance and for larger businesses to provide it to their employees. It also includes a public health insurance option that is not tied to Medicare. But most of the $1.052 trillion cost of the bill comes in the form of subsidies to help low- and middle-income people purchase insurance.The White House had representatives stationed outside of the Democratic cloakroom late Saturday, checking periodic printouts of vote counts.

Nancy-Ann DeParle, the director of the White House’s healthcare reform office, and Dan Turton, the White House’s deputy director of Legislative Affairs for the House, huddled with several other administration staffers as they counted the very last votes needed for passage on the cloakroom television through the open door.

“215, 216, 217…” they whispered. And then with the magical 218th vote, they erupted in hugs and cheers.

After the bill’s final passage, Turton turned to DeParle, who closely shepherded the measure through the House and will continue to play a vital role in its movement through the Senate, and he imparted some congratulatory words of advice.

“So what you’re going to want to do is go up here, take a right and down that hallway will take you to the Senate,” he said with a laugh.
Dozens of House Democrats and White House staffers also gathered in the House Ways and Means Committee room after the measure’s passage and celebrated with hugs, cheers, and toasts of red and white wine.

Supporters called the passage a historic moment on par with the New Deal and the creation of Medicare. They said the bill will finally guarantee health coverage to nearly every American.
"This legislation will mean affordability for the middle-class, security for our seniors, and honors our responsibility to our children, adding not one dime to the deficit," said House Speaker Nancy Pelosi (D-Calif.).

Republicans derided the bill as a massive government takeover of an industry that account for one-sixth of the U.S. economy. They also sought to exploit recent fights among Democrats about abortion and immigration. They warned that the Democratic bill would pave the way toward taxpayer-funded abortions and coverage for illegal immigrants.

"Generations unborn are crying out to us tonight to preserve their freedoms," said Rep. Michelle Bachmann (R-Minn.), who had drawn thousands of conservative "tea party" activists into the halls of Capitol office buildings on Thursday to protest the bill.
Republican Reps. Joe Wilson (S.C.) and John Boozman (Ariz.) walked off the House floor following the vote with arms thrown over each other’s shoulders.

“You did good, Joe,” said Boozman to Wilson, who had co-hosted a second “House Call” rally of conservative demonstrators on the Capitol’s East front lawn earlier in the day.
Despite the significant and historic step that Democrats were able to take on Saturday, it could be months before a bill goes to the president's desk. And the bill that House and Senate negotiators ultimately produce could be vastly different than the one agreed to by a bare majority of the House.

The Senate is moving more slowly on its draft of the healthcare bill, and it could be next year before it votes on a bill, injecting election-year politics more deeply into the debate. Senate Majority Leader Harry Reid (D-Nev.) is in the process of drafting a bill that combines the work of two Senate committees.

The vote came hours after a noon pep rally where President Barack Obama urged his fellow Democrats to get the healthcare bill past the goal line. He acknowledged fears that some of them were taking votes that could anger their constituents and cost them their seats next year.
It can get tough, working on this issue, making these tough decisions," Obama said. "But remember why you got into politics in the first place. And when you do, remember that we can’t afford to let this moment pass.”

Democratic leaders had hoped to hold the House vote before the August recess, but a rebellion by centrist Democrats, particularly Blue Dogs, forced them to delay. The bill's chances dimmed the next month, when conservative activists stormed lawmakers' town hall meetings decrying it as a "government takeover."

The tide turned in favor of the bill in the weeks following August, as polls showed increasing support for the public option. But it suffered a setback Tuesday night when many centrist Democrats were spooked by Democratic losses in two off-year gubernatorial elections.

Most of the debate in recent weeks had been an intra-party feud between liberals and centrists about what form the public option could take. Liberals lost when they couldn't produce 218 votes. But the final hours were consumed with a debate over how to maintain the status quo on abortion. Federal law has prevented taxpayer dollars from funding abortions for decades. But the Democrats' proposed expansion of the federal role in healthcare would make it trickier to block such funding while maintaining access to abortion services.

Abortion opponents prevailed, passing a measure blocking any of the subsidies in the plan from going to abortion. Abortion-rights supporters call it a "de facto" abortion ban and mounted an intense lobbying campaign against it, but 64 Democrats joined nearly all Republicans in voting for it. The only Republican not to vote for it -- voting "present" in an attempt to derail the main bill -- was Rep. John Shadegg (R-Ariz.).

The abortion vote showed a sharp divide in the caucus, but it was followed quickly by a show of unity when the bill passed.

When the tally of "yes" votes reached the magic number of 218 with more than four minutes left in the vote, a cheer went up. A few minutes later the Democrats counted the last few seconds of the vote and gave another cheer.

The only true suspense was how Cao would vote. The Louisiana Republican was elected in a heavily Democratic district and is considered the most endangered Republican in the House.

Shortly into the vote, House Minority Whip Eric Cantor (R-Va.) walked over to where Cao was sitting, squeezed past Cao and Rep. Don Young (R-Alaska) and sat next to him. Cao waited until the vote reached 218, then took out his voting card and voted "yes." Cao's yes vote put a thin sheen of bipartisanship on the bill, and kept Republicans from unanimously opposing their second high-profile bill this year. No Republicans voted for Obama's stimulus.

Democrats didn't emphasize the one Republican vote.

"We're glad to take responsibility for this bill," Pelosi said at a press conference after the bill passed, "and the credit."