This is the VOA Special English Economics Report.
A major reform of the American system of health care and insurance has moved farther in Congress than ever before. President Obama wants a final bill passed by the end of the year. But a difficult road still lies ahead.
Saturday night, the House of Representatives passed a bill with an estimated trillion-dollar price over ten years. The president called the vote historic.
BARACK OBAMA: "The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance, quality affordable options for those who don't and bring down the cost of health care for families, business and our government while strengthening the financial health of Medicare."
But thirty-nine Democrats voted no, and only one Republican, Joseph Cao of Louisiana, voted yes. The bill passed with just two more votes than required. Republicans say the plan would add to the nation's debt, raise insurance costs and expand government involvement in health care.
Representative Joe Barton is a Republican from Texas.
JOE BARTON: "So, there is a choice. Bigger government, more mandates, more control, less freedom. Or lower costs, more opportunity, more freedom or more choice. I vote for more freedom."
The bill aims to provide health coverage to thirty-six million Americans. That would raise the nation's coverage rate to about ninety-six percent.
The most disputed part of the bill is a "public option" for individuals and small businesses. The government would compete with private plans by offering it own insurance -- based on payment rates negotiated with providers.
The House bill would raise taxes on high earners to help pay for the plan. It would also cut four hundred billion dollars from health programs for the retired and poor -- money that supporters of the bill say is now being wasted.
Most Americans would have to buy insurance or pay a fine; the government would help the needy. All but the smallest businesses would have to offer insurance for their workers or pay a tax. Some small businesses could receive tax credits to help with their costs.
Insurance companies could not deny or cancel coverage for people with pre-existing conditions. And the industry would lose its protection from anti-competitive laws.
Now, Harry Reid, the Democratic majority leader, is working to produce a health care bill in the Senate. Two bills passed by committees must be combined into one. If that passes, then a compromise would be needed with the House version.
But there is strong resistance in the Senate to a public option. Also, the Senate proposals would not require employers to provide coverage, but would offer tax credits to those that do.
And that's the VOA Special English Economics Report, written by Mario Ritter. I'm Steve Ember.
Correction: An earlier subheadline over this story overstated opposition to a "public option" by saying the idea had "little support" in the Senate.