House passes healthcare plan : The 220-215 vote marks the first such victory in decades of efforts.

The House of Representatives on Saturday approved the most sweeping healthcare legislation since the creation of Medicare 44 years ago, giving a boost to President Obama’s campaign to guarantee health coverage to almost all Americans.

The gargantuan Democratic measure passed 220 to 215, with a single Republican vote, capping a contentious daylong debate that underscored the ideological divide separating the two parties over healthcare.

The narrow Democratic victory underscored the difficult road ahead as the issue moves on to the Senate. But it also meant that the party had reached a historic landmark: It has been trying since the Depression to win a vote to extend the government’s social safety net to include healthcare.

The House plan would cover an additional 36 million people by 2019, leaving 4% of the nation without coverage, compared with the estimated 17% who do not have insurance now, according to the nonpartisan Congressional Budget Office.

“For generations, the American people have called for affordable, quality healthcare for their families. Today, the call will be answered,” said House Speaker Nancy Pelosi (D-San Francisco), who rallied her members behind the legislation after weeks of cajoling and deal-making.

The Democratic side of the House cheered loudly when the vote count reached 218, a majority. Like a crowd waiting for the final gun at a football game, they counted down the final seconds of the voting period in unison, and roared their approval when Pelosi went to the speaker’s chair, grabbed the gavel and declared, “The bill is passed.”

President Obama hailed the vote in a statement from Camp David, saying: “Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Republicans, who have fought Obama’s healthcare campaign for most of the year, charged Democrats with pushing the nation toward government-run healthcare and threatening to bankrupt the treasury at a time when the deficit is skyrocketing.

“People have a grave concern about what Washington is doing to them, not for them,” Rep. Eric Cantor of Virginia, the No. 2 House Republican, said Saturday, citing last week’s GOP electoral victories in Virginia and New Jersey.

Louisiana Rep. Anh “Joseph” Cao was the only Republican to cross the aisle and vote for the bill. Thirty-nine Democrats voted against it.

The legislation -- which includes more than $1 trillion in new healthcare spending over the next decade while also reducing the deficit by an estimated $106 billion -- will ultimately have to be reconciled with the Senate bill.

Senate Majority Leader Harry Reid (D-Nev.) is working to unite his members in time to hold a vote on the Senate bill before Christmas.

With the unemployment rate continuing to rise and the public increasingly jittery about Obama’s healthcare campaign, Democrats are racing to push through an overhaul before what many see as a historic opportunity slips away.

Pelosi had hoped to get a bill through the House sooner than November. But she and her lieutenants had to spend months hammering out a series of difficult compromises to satisfy the liberal and conservative wings of the party.

New requirements on businesses and insurance companies have alienated major industry groups, many of which actively fought the House bill, charging that it would actually make healthcare less affordable.

“The healthcare reform bill just passed by the House of Representatives fails the crucial test of reducing the soaring cost of health coverage for businesses or individuals,” U.S. Chamber of Commerce Executive Vice President Bruce Josten said after the vote.

But even as opposition to the bill stiffened, Democratic leaders managed to defuse major disagreements over the shape of a new government insurance plan and the scope of new income taxes on wealthy Americans.

They picked up major endorsements from AARP and the American Medical Assn., which joined a collection of leading consumer and patient groups and labor unions that have backed the healthcare campaign all year.

And facing the possible collapse of the legislation late Friday night, Democratic leaders brokered a deal to settle a debate within party ranks over abortion.

Under pressure from a group of socially conservative Democrats and the U.S. Conference of Catholic Bishops, Pelosi and other lawmakers who favor abortion rights were forced to accept a last-minute compromise that placed tight restrictions on federal funding for abortion services.

The amendment was added to the bill Saturday by a coalition of 240 Republicans and conservative Democrats; 194 Democrats voted against the amendment.

The move outraged many liberals. But in the end, just enough rallied behind the bill after a furious several days of lobbying by party leaders, including the president.

“There comes a time [when] men must act according to the dictates of their conscience and not according to political expediency,” Rep. John Lewis (D-Ga.) said on the House floor. “We have a moral obligation to lead this nation into a new era where healthcare is a right and not a privilege.”

Obama, too, called on lawmakers to seize the moment, reminding them during a midday visit to Capitol Hill of the party’s successful fights to create Social Security and Medicare.

“If we do not get it done this year, we will not get it done any time soon,” the president said at a closed-door meeting, according to a senior Democratic aide who was in the room.

The more than 2,000-page legislation is designed to largely preserve the employer-based healthcare system in which most Americans get insurance through work. But the bill would also dramatically expand federal regulation of healthcare and provide more than $1 trillion in new aid to poor and middle-class citizens.

Federal law would for the first time require insurance companies to cover all Americans, regardless of their health status, and would prohibit insurers from denying coverage to people who become sick.

Individuals would be required to buy insurance. And large employers would have to provide employees with health benefits or face a penalty.

The bill would open the nation’s 44-year-old Medicaid insurance program for the poor to all Americans making less than 150% of the federal poverty line -- $16,245 for an individual or $33,075 for a family of four.

The government would also create new insurance marketplaces for millions of Americans who do not get coverage through work.

Commercial insurers, as well as the government, would offer plans in these marketplaces, or exchanges, and be required to provide a minimum set of benefits, including mental health services, maternity care and preventive care.

The most expensive feature is a commitment by the federal government to provide nearly $600 billion in subsidies over the next decade to help millions of low- and moderate-income Americans buy insurance in an exchange.

The bill is also designed to give relief to small businesses, providing about $25 billion in tax subsidies to help them offset the cost of offering their employees health benefits.

And the legislation would make prescriptions more affordable by closing the Medicare drug coverage gap, known as the “doughnut hole.”

The major expansion in federal assistance to tens of millions of Americans is not without a cost.

To pay for their legislation, Democrats approved a 5.4% surtax on individuals who make more than $500,000 a year and couples that make more than $1 million.

The bill would also cut more than $400 billion from Medicare payments to hospitals, nursing homes and insurance companies that provide Medicare Advantage plans, a provision that proponents hope will ultimately help make the system more efficient.

Republicans contend that many seniors will lose benefits, and they more broadly attacked the bill as a costly government invasion of the medical system.

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noam.levey@latimes.com

janet.hook@latimes.com

Staff writer Kim Geiger contributed to this report.