(RFE/RL) -- U.S. President Barack Obama has achieved a landmark victory of his presidency in securing passage of a health care reform bill through the House of Representatives.
Extending health insurance to tens of millions of Americans who until now were outside the scope of existing programs was one of the major pledges Obama made to the American people in his election campaign.
Speaking at the White House after the historic vote on March 21, Obama said, "In the end, what this day represents is another stone laid firmly in the foundation of the American dream."
"When faced with crisis, we did not shrink from our challenge, we overcame it. We did not avoid our responsibility, we embraced it. We did not fear our future, we shaped it," Obama added.
The success of the reform bill comes after more than a year of intensive lobbying by the president and his Democratic Party in Congress. Against implacable opposition from Republicans and conservative Democrats, the bill passed by 219 votes to 212. It now has to return to the Senate for further votes, and may be signed into law by Obama as early as next week.
The health measure has divided Washington's political establishment as few other issues have in recent times. Representative Geoff Davis, a Republican, speaking on the floor of the House, expressed his party's "grief."
"This vote will define the America we will have in the future: massive tax burdens, rationed care, intrusive bureaucracy. Democrats are thwarting the view of the American people today, taking them on a headlong rush towards socialism," Davis said.
The deep differences of view have an ideological basis. American liberals have as their war cry that health care for all "is a right, not a privilege."
Conservatives and Republicans by contrast view as un-American the intrusion of "big government" into what they see as essentially a private matter for the citizens to decide for themselves. They say the estimated cost over the next decade of $900 billion will only plunge the government dangerously deep into debt.
Under the legislation, most Americans are required to purchase insurance, and they face penalties if they refuse. The measure provides subsidies to help low-income families pay their insurance premiums.
The privately run health insurance industry will also come under new federal regulation. It will be forbidden to deny coverage because of pre-existing medical conditions and from canceling policies when a policyholder becomes ill. The measure also imposes some new taxes on the wealthy.
Many of the reform bill's provisions do not come fully into force until 2014, and Democrats worry that the public may become disillusioned during the long wait.
Certainly the Republicans have vowed to continue the fight, and even to repeal the measure if they win enough seats at the coming mid-term congressional elections in November.