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.

On November seventh, the House of Representatives passed a bill with an estimated trillion-dollar price over ten years. The president called the vote historic.

President Obama said the Affordable Health Care for America Act will provide stability and security for Americans who have insurance. It will provide quality affordable options for those who don't. And it will bring down the cost of health care for families, business and the 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.

Republican Representative Joe Barton from Texas said: "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.

And that's the VOA Special English Economics Report. You can read more about the health care debate at voaspecialenglish.com.