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US President Barack Obama has made one of the most important speeches of his presidency, as he faced Congress over his plans for healthcare reform. Mr Obama said that failure to introduce reform had led the country to breaking point and it was now time to act. He said he planned to improve health insurance for those who have it and to create an insurance exchange to extend cover to those who do not. Republicans said Mr Obama's plans would make healthcare much more expensive.Mr Obama told Congress that the US was the only developed country that allowed millions of its people to endure the hardship of going without healthcare. "Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy," he said. "These are not primarily people on welfare. These are middle-class Americans." But Mr Obama said the current system did not serve well those Americans who do have health insurance either. "Those who do have insurance have never had less security and stability than they do today. "More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too." He said the US spent one-and-a-half times more on health insurance than any other country but Americans were no healthier than other people. Mr Obama set out details of his plan to reform the system. He said that nothing in his proposal would require Americans who already have health insurance to change their coverage or doctor. But he said he would make the insurance work better for individuals by prohibiting insurers from dropping coverage for sick patients or by capping it. He would also require insurers to cover the cost of routine check-ups and preventative care. For the millions of uninsured Americans, he said he would create an insurance exchange - a market place where individuals and small business will be able to shop for health insurance at competitive prices.