The US House of Representatives has given final approval to a sweeping healthcare overhaul, expanding insurance coverage to nearly all Americans and handing president Barack Obama a landmark victory.

On a hard-fought 219-212 vote, House Democrats approved the most dramatic health policy changes in 40 years. The vote sends the bill, already approved by the Senate, to Mr Obama to sign into law.

“After decades of trying and a year of sustained effort and debate, the US Congress finally declared that America’s workers, families and small businesses deserve the security of knowing that neither injury nor accident will endanger the dreams they’ve worked a lifetime to achieve,” Mr Obama said soon after the vote.

The overhaul extends insurance coverage to 32 million Americans, expands the government health plan for the poor, imposes new taxes on the wealthy and bars insurance practices such as refusing to cover people with pre-existing medical conditions.

Its passage capped a year-long political battle with Republicans that consumed the US Congress and dented Mr Obama’s approval ratings, and fulfilled a goal that eluded Democrats since former president Bill Clinton’s failed attempt in 1994.

“This isn’t radical reform, but it is major reform. This legislation will not fix everything that ails our healthcare system, but it moves us in the right direction … this is what change looks like,” Mr Obama said.

He said that despite the predictions of pundits that it was not possible to pass the mammoth bill, Americans had risen above their differences.

“Tonight we answered the call of history as so many Americans have before us. We did not avoid our responsibility. We embraced it. We did not fear our future. We shaped it.”

Democrats hugged and cheered in celebration as the vote count hit the magic number of 216 and chanted: “Yes we can.”

Every Republican opposed the bill and 34 Democrats joined them in voting against it.

Republican and industry critics said the 10-year, $US940 billion ($1.02 trillion) bill was a heavy-handed intrusion in the healthcare sector that will drive up costs, increase the budget deficit and reduce patients’ choices.

Both parties geared up for another battle over the healthcare bill in the campaign leading up to November’s congressional elections, and opponents across the country promised to challenge the legislation at the state level.

The healthcare revamp, Mr Obama’s top domestic priority, will usher in the biggest changes in America’s $US2.5 trillion healthcare system since the 1965 creation of the government-run Medicare health program for the elderly and disabled.

It would require most Americans to have health coverage, gives subsidies to help lower-income workers pay for coverage and creates state-based exchanges where the uninsured can compare and shop for plans.

Major provisions such as the exchanges and subsidies would not kick in until 2014, but many of the insurance reforms like barring companies from dropping coverage for the sick will begin in the first year.

Heavy lobbying

The vote followed days of heavy lobbying of undecided House Democrats by Mr Obama, his top aides and House leaders.

The narrow victory was clinched by a deal designed to appease a handful of Democratic opponents of abortion rights.

Under the deal, Mr Obama will issue an executive order affirming government restrictions on the use of federal funds for abortion.

That pledge won the support of Representative Bart Stupak and a handful of other House Democratic abortion rights opponents, who had threatened to vote against the Senate-passed bill because they said its abortion restrictions were not strong enough.

The health insurance industry has vigorously opposed the plan, but insurance stocks rallied late last week as investors began to realise their worst fears had not materialised.

Pharmaceutical companies, hospitals and others will benefit from more insured patients, and the bill does not allow the government to cap prices and premiums, which would have hurt drugmakers and insurers.

Opinion polls show the public also has a mixed view. While pluralities oppose the legislation and the process has turned off many Americans, some of the bill’s individual components draw heavy support.

- Reuters