U.S. President Barack Obama commended what he called a "courageous" vote for members of Congress who passed a historic health care reform bill late Saturday, legislation that, if enacted, will extend coverage to tens of millions Americans who are currently uninsured.

"I know this was a courageous vote for many members of Congress and I am grateful to them and the rest of their colleagues," Obama said in a news conference Sunday.

He said if the law passes, the U.S. will be able to protect Americans from "abuses" by insurance companies who deny or revoke coverage for people who have preexisting conditions, or reach a lifetime maximum.

He said it now falls on the U.S. senate to "take the baton and bring this effort to the finish line on behalf of the American people."

The House bill is projected to expand coverage to 36 million people who don't have insurance. The United States is the only developed nation that does not have a comprehensive national health care plan.

The bill passed Saturday with a 220-215 vote tally and will now head to the Senate for what will no doubt be more heated debate.

But in the Senate, more than a simple majority is needed for passage, and it will be a tough fight.

Several centrist Democrats still have reservations, particularly about establishing a government-sponsored insurance program, or public option, to compete with private insurers.

"The House bill is dead on arrival in the Senate," Republican Sen. Lindsey Graham of South Carolina said Sunday. "It was a bill written by liberals for liberals."

Nearly all of Congress' Republicans opposed the contentious legislation, which they say amounts to a government takeover of health care.

Rep. John Dingell, 83, who has attempted to introduce national health insurance legislation in Congress since 1955, said the bill is good for Americans.

"It provides coverage for 96 percent of Americans," Dingell said of the bill. "It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it."

In several hours of debate in the House, a number of Republicans voiced their displeasure.

"We are going to have a complete government takeover of our health care system faster than you can say, `this is making me sick,'" said Rep. Candice Miller of Michigan.

Only one Republican, Rep. Joseph Cao of New Orleans, voted for the bill, while another 176 opposed it. Thirty-nine Democrats opposed the bill.

Before the vote, conservatives from both sides of the floor pushed through new restrictions on abortion coverage in insurance policies for individuals and small groups.

Other stipulations in the $1.2 trillion legislation include:

  • Most Americans would be required to have insurance. Federal subsidies would assist those who cannot afford coverage.
  • Large employers would be required to offer health coverage to their employees.
  • Insurance companies would no longer be allowed to deny coverage due to pre-existing conditions, and they would have to stop the practice of charging higher premiums due to gender or medical history.
  • Insurers would also no longer be exempt from federal antitrust regulations that govern price fixing and market allocation.

One of the most contentious aspects of the legislation is the fact that the federal government would also sell insurance. According to the Congressional Budget Office, premiums for government plans would likely be higher than private plans.

The staggering cost of the legislation is to be paid for by more than $400 billion in cuts to Medicare over a 10-year period, as well as a 5.4 per cent tax on individuals who earn more than $500,000 and families that earn more than $1 million.

In the Senate, the bill will need 60 of 100 votes to move on to final debate. If the Senate passes a bill, it will first have to be reconciled with the House version by a Congressional panel before it can go to a final vote.

With files from The Associated Press