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The House bill is estimated to expand coverage to about 96 percent of eligible Americans. Beginning in 2013, it would provide government subsidies to extend coverage to tens of millions who now lack it, and ban insurance company practices such as denying coverage to people with pre-existing medical problems.

For the three years before the federal aid starts flowing, the bill would set up a temporary "high-risk pool" through which people who have been denied coverage because of poor health could obtain a government-subsidized policy.

The bill would set up health insurance "exchanges" through which self-employed people and small businesses could buy coverage, either from a private insurer or a new government plan that would compete. All the plans sold through the exchange would have to follow basic consumer protection rules, making it easier to shop and compare among them.

The majority of middle-class Americans covered under big employer plans would not see dramatic changes. But coverage for the poor through Medicaid would be significantly expanded.

Seniors in traditional Medicare would get improved preventive benefits. Also, the prescription coverage gap known as the "doughnut hole" would be gradually closed. However, seniors signed up for private insurance plans through Medicare could lose some benefits, as the bill scales back extra payments that the plans have been getting.

In addition to raising money by cutting payments to hospitals and other medical providers, the House bill boosts taxes on upper-income earners. Democrats also moved Tuesday to close a biofuel tax credit loophole, raising about $23 billion to help pay for the legislation.

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Associated Press writers David Espo and Alan Fram contributed to this story.

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