The US House of Representatives voted 219-212 on March 21 to approve President Barack Obama’s $940 billion, 10-year health reform, and he could now sign the bill into law as early as Tuesday (March 23).

No Republicans supported the bill – which is a modified version of the Senate version passed in December - but the Democrats won their battle with three votes to spare. Speaking just ahead of the vote, House Speaker Nancy Pelosi said: “we will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans.”

"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction," added the President.

The number of uninsured Americans who will now have health care coverage is put as high as 32 million – a huge new customer base for the pharmaceutical industry. Drugmakers will pay more in fees than originally proposed; the Senate bill’s planned annual $2.3 billion annual levy on the industry has been replaced with yearly fees totalling $2.5 billion for 2011, rising gradually to $4.2 billion in 2018, after which they will decline to a regular annual total of $2.8 billion.

But a number of industry-opposed initiatives contained within earlier versions of the legislation were dropped from the final bill. These include a requirement for government/industry price negotiations for the Medicare prescription drug programme, allowing US consumers to buy re-imported prescription drugs from overseas and a ban on “pay-for-delay” deals between brand-name and generic drugmakers.

Another plus for the industry is that the bill will close, by 2020, the Medicare “doughnut hole” coverage gap, under which the programme stops paying a beneficiary’s prescription drug costs after they reach $2,830 in a single year and then resumes when the individual’s out-of-pocket expenses exceed $4,550. Drugmakers’ contribution to this will be around $3 billion annually over nine years, but they will retain many customers who, having reached the doughnut hole in the past had switched to generic versions of their brand-name drugs, reduced their medications or simply stopped taking them altogether.

Broadly welcoming the vote, the Pharmaceutical Research and Manufacturers of America (PhRMA) said the legislation, while not perfect, is a step towards giving all Americans access to high-quality, affordable health care coverage and services.

"Our commitment to help pay for health care reform will require all of our companies to make some difficult choices moving forward – on top of already losing more than 150,000 jobs since 2007 because of the recession and other economic factors,” the group added.

However, Jon Leibowitz, chairman of the Federal Trade Commission (FTC) which has battled to get “pay for-delay” deals banned, pledged that the fight will go on. These "unconscionable deals” cost consumers around $3.5 billion a year, and “it’s not a question of whether,” but when, they are stopped, he said last week.

- In a second (220-211) vote on Sunday, the House also approved a package of legislative changes to the upper house bill, and this will now go to the Senate for debate and a vote this week.