WASHINGTON (AP) — In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote cleared the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later.

“It provides coverage for 96 percent of Americans. 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,” said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government’s mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

The bill includes the “Hirono amendment,” which provides an exemption for Hawai‘i’s Prepaid Health Care Act, as long as it meets or exceeds the national standards in H.R. 3962.

Hawai‘i’s Prepaid Health Care Act applies to certain full-time employees and their employers. It does not apply to part-time employees, seniors on Medicare, those without health insurance, government employees, or those covered by collective bargaining agreements. Therefore, H.R. 3962 would apply to them, a news release from Hawai‘i Democratic Rep. Mazie Hirono’s office says.

“Congress at long last is taking steps to address the long-festering problem of how to make affordable health care available to all Americans without adding to our deficit,” she said in a statement. “It’s taken more than 60 years to get here — and the forces in support of the status quo are powerful foes indeed. They have resorted to scare tactics and outright lies to fight this bill tooth and nail. And it’s not over yet.”

The Affordable Health Care for America Act establishes sweeping health care reforms in a way that reduces the deficit, provides stability and security for Americans who currently have health insurance, and an affordable, quality public option for those without coverage, the release says. The bill also strengthens Medicare for seniors by improving benefits, including closing the ‘doughnut hole’ on prescription drug coverage.

“This bill protects vulnerable families by ending the practice of discriminating against consumers for pre-existing conditions,” Hirono said. “This bill stops the insurance companies from charging more to cover women simply because of their gender. Another important consumer protection provision the bill establishes is the creation of a process for annual insurance rate review with the goal of keeping private insurance companies accountable to their customers.”

Rep. Neil Abercrombie, D-Hawai‘i, said in a statement that he voted for healthcare reform because it makes healthcare more affordable and accessible for Hawai‘i families and it protects the state’s Prepaid Health Care Act.

“We’ve been ahead of the rest of the country since 1974, and this legislation will not change that,” he said.

The release from Abercrombie’s office details the following changes:

∫ It provides tax credits to help as many as 116,000 Hawai‘i families pay for healthcare insurance. These are families who can't afford it now.

∫ It improves Medicare services for 105,000 Hawai‘i Seniors. It closes the prescription drug 'donut hole' that forces 11,900 people here to pay more than they should for medicine.

∫ It ensures that 3,800 people in Hawai‘i can't be prevented from getting health insurance because of pre-existing medical conditions.

∫ It makes healthcare coverage more affordable for 15,000 of our small businesses. As many as 13,200 of them will be eligible for tax credits to help reduce costs.

∫ It will help an estimated 500 Hawai‘i families avoid bankruptcy every year from crushing medical costs.

∫ It reduces the $69 million dollars we pay every year for uncompensated medical care. Today, our local and state governments cover about 75 percent of it, and Hawai‘i families pay an extra $700 a year in health insurance premiums.

∫ If you get your healthcare through your job, the Healthcare Reform Plan will improve the coverage by:

∫ Limiting exclusions for pre-existing conditions (Effective Jan. 1);

∫ Prohibiting health insurance companies from canceling coverage except in cases of fraud (Effective July 1);

∫ Requiring health insurers to allow individuals up to the age of 27 to remain on their parents' health insurance (Effective Jan. 1);

∫ Prohibiting health insurers from imposing lifetime limits on benefits (Effective Jan. 1);

∫ Prohibiting employers from reducing retiree health benefits below what was offered at the time of their retirement unless reductions are also made to active workers' health benefits (Effective on date of enactment);

∫ Prohibiting insurers from limiting or denying coverage based on injuries stemming from domestic violence (Effective Jan. 1); and

∫ Requiring plans to pay for reconstructive surgery for children with deformities (Effective Jan. 1).

“The legislation we approved tonight is not perfect, nor is it the final word on healthcare,” Abercrombie said. “But it is a momentous step. Healthcare reform has been talked about since the 1950s, yet proponents have never been able to overcome the special interests that make a lot of money under the present system and want to keep things just the way they are. They've had things their way for a long time. It’s your turn.”

The Garden Island contributed to this report.