With Democrats wielding their sizable majority to fend off strong Republican opposition and survive the defection of 39 members of their own party, the U.S. House of Representatives voted 220 to 215 to approve health care reform legislation after a day of contentious debate. On November 7, as midnight drew near, 219 House Democrats and 1 Republican (Representative Anh “Joseph” Cao of Louisiana) approved a measure that would extend insurance coverage to virtually all Americans by 2013. The 1990-page bill would also restructure private insurance, bolster primary care, and make countless other policy changes — but would not eliminate the scheduled 21.2% reduction in Medicare's physician fees, a problem that Democrats plan to tackle in separate legislation before the cuts take effect January 1, 2010. Meanwhile, the action on a health care overhaul moves to the Senate, where Majority Leader Harry Reid (D-NV) has crafted a bill as a compromise between two committees' measures and floor debate awaits only a cost estimate from the Congressional Budget Office. And President Barack Obama has weighed in, urging senators to “take up the baton and bring this effort to the finish line.”