WASHINGTON — The Senate Thursday passed by 56-43 the final piece of landmark health care legislation that's intended to change dramatically how most Americans buy, use and maintain insurance coverage.
Because of a technical glitch, the House of Representatives also must pass it again, which was to occur virtually automatically later Thursday, according to House Speaker Nancy Pelosi, D-Calif.
This measure, combined with the one signed into law on Tuesday, will bring the most significant change in health care policy since Medicare was created in 1965 to provide health insurance coverage for seniors and the disabled.
The new laws will extend health insurance coverage to 32 million people who currently are uninsured. They will expand coverage to 94 percent of eligible Americans. Consumers will find a host of changes in how they deal with doctors, insurers, hospitals and the rest of the health care system.
Most people will have to obtain coverage by 2014 or face penalties. Most employers would have to offer policies by then, and consumers will be able to shop for coverage through new exchanges, or marketplaces.
Several provisions will take effect within the next year. Medicare prescription drug beneficiaries will get a $250 rebate this year.
By fall, insurers will no longer be able to put lifetime caps on coverage, and must permit young people to remain on their parents' policies until their 26th birthday. Insurers also will be barred from dropping people when they get sick and from refusing coverage to children with pre-existing conditions.
During fiscal 2010, which begins Oct. 1, the legislation provides new investments in training for new primary care physicians and nurses, as well as additional money for community health centers so they can double the number of patients they serve.
Starting in January 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Those in larger group markets would have to spend 85 percent. If they don't comply, they would have to give consumers rebates.
The bill approved Thursday, called "reconciliation" because it "fixes" the broader health care bill that Obama signed into law Tuesday, was part of a political deal needed to get both measures through Congress.
House Democrats had objected to several provisions in the new law, notably an excise tax on high-end insurance policies that labor unions fought, as well as a series of special deals for individual lawmakers. The reconciliation bill delayed the tax until 2018, and some of the controversial deals were eliminated.
The bill will give more government help with insurance premiums for lower and middle class families and aid to states for Medicaid, the state-federal health program for lower-income people.
To help pay for the changes, wealthier people will pay more Medicare payroll tax starting in 2013.
Single people who earn more than $200,000, and joint filers making more than $250,000, will see the tax increase by 0.9 percentage points in 2013, to 2.35 percent, and will pay a new 3.8 percent tax on dividends, interest and other unearned income.
The reconciliation bill's passage has been assured all week. Republicans tried to insert changes, forcing votes on 40 amendments or procedural points, but Democrats rejected each on party line votes Wednesday and Thursday.
The GOP's effort seemed to lose steam as the "vote-a-rama," a series of nonstop votes that lasted until 2:45 a.m. Thursday, progressed.
Then, GOP opponents turned their attention to November's elections. Their floor speeches and statements outlined themes they're likely to stress as they return home this weekend and throughout the year.
Senate Republican Leader Mitch McConnell of Kentucky called the health care vote "a turning point in our politics and our nation."
He called the measure "a vast expansion of the entitlement state that we can't afford, massive cuts to Medicare, higher taxes, higher health care costs, worse care, taxpayer-funded abortions and don't believe the spin: This wasn't a party line vote. A whole lot of Democrats voted against it."
Thirty-four Democrats opposed the major bill in the House; 33 opposed reconciliation.
But Democrats insisted they now have strong arguments to make, claiming the bill will provide more jobs, more peace of mind and reduce the federal deficit. The nonpartisan Congressional Budget Office estimates the $938 billion measure will reduce deficits by $143 billion over the next 10 years.
"As we start the spring by closing a chapter in health reform's long history, it's really a new beginning for all America," said Senate Majority Leader Harry Reid of Nevada.