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WASHINGTON – After months of struggle, House Democrats rolled out sweeping legislation Thursday to extend health care coverage to millions who lack it and create a new option of government-run insurance. A vote is likely next week on the plan largely tailored to President Barack Obama's liking.

Speaking on the steps of the Capitol, Speaker Nancy Pelosi said Congress was at a "historic moment" with lawmakers "on the cusp of delivering on the promise of making affordable, quality health insurance available to every American."

Officials said the measure, once fully phased-in over several years, would extend coverage to 96 percent of Americans. Its principal mechanism for universal coverage is creation of a new government-regulated insurance "exchange" where private companies would sell policies in competition with the government. Federal subsidies would be available to millions of lower-income individuals and families to help them afford the policies, and to small businesses as an incentive to offer coverage to their workers.

Large firms would be required to cover workers, and most individuals would be required to carry insurance.

The ceremony marked a pivotal moment in the Democrats' yearlong attempt to answer Obama's call for legislation to remake the nation's health care system by extending insurance, ending industry practices such as denying coverage on the basis of pre-existing medical conditions, and slowing the growth of medical spending nationwide.

Across the Capitol, Senate Democrats, too, are hoping to pass legislation by year's end. Legislation outlined by Majority Leader Harry Reid earlier this week would include an option for a government-run plan, although states could drop out if they wished, a provision not in the House measure.