Following a year of fierce partisan debate that deeply divided Republicans and Democrats, President Barack Obama signed a $940 billion health care bill into law Tuesday that will extend coverage to more than 30 million uninsured Americans and outlaw some of the health insurance industry's most controversial practices, such as dropping individuals from their plans when they get sick.
But it's also a law that now requires Americans to purchase health insurance or pay a fine, a provision that has angered progressives who said the mandate is a gift to private health insurance companies.
"Today, after almost a century of trying, today, after over a year of debate, today, after all the votes have been tallied, health insurance reform becomes law in the United States of America," Obama said at a signing ceremony, where he was flanked by Democratic leaders, including House Speaker Nancy Pelosi. "The bill I am signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see."
Obama said he was signing the bill into law "on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days."
Pelosi said Obama's signature on the legislation "completed what the late Sen. Edward Kennedy called 'the great unfinished business of our society.'" She added that "health insurance reform will stand alongside Social Security and Medicare in the annals of American history."
Kennedy had been a staunch proponent of universal health care, and though the bill lacks the sweeping reforms he had championed, he supported Obama's efforts until his last days.
Sen. John McCain (R-Arizona), the former GOP presidential candidate, said Republicans will not cooperate with Democrats on any piece of legislation "for the rest of this year."
"They have poisoned the well in what they have done and how they have done it," McCain said during an interview Monday with KFYI radio in Arizona. It's worth noting that since Obama was sworn into office last year Republicans have refused to support most of the Democrats' legislative initiatives.
The buildup to Sunday's vote was marred by death threats against Obama on Twitter by a conservative blogger and racist and homophobic epithets directed at Democratic Reps. Barney Frank, who is openly gay, and John Lewis, who is African American, by Tea Party activists as the lawmakers entered the Capitol.
Nearly 10 hours later, the House passed the Patient Protection and Affordable Care Act, a version of the bill the Senate approved last December, by a vote of 219 to 212. All 178 Republicans and 34 Democrats voted against the measure.
From a policy standpoint, it is the most significant victory Democrats have achieved in nearly half a century. Overhauling the nation's health care system was the cornerstone of Obama's domestic agenda and has been the president's primary focus since he was sworn into office.
To secure enough votes to win passage of the bill, Obama said Sunday he will sign an executive order reaffirming that federal funds would not be used to subsidize abortions, a move aimed to appease pro-life Democrats such as Rep. Bart Stupak (D-Michigan), who vowed to oppose the legislation unless it included tougher anti-abortion language.
A package of legislative fixes the House passed after the vote was immediately sent to the Senate where lawmakers will use the budgetary procedure known as reconciliation to win approval by a simple 51-vote majority and block a Republican-led filibuster.
Senate Majority Leader Harry Reid said the goal is to pass the bill by Friday or Saturday.
While Republicans continued to rail against the bill (Republican National Committee Chairman Michael Steele called it a "socialist scheme" in a letter to supporters after Sunday's vote) and claim that it will bankrupt the country, despite a Congressional Budget Office analysis that said the legislation will reduce the deficit by $138 billion over the next 10 years, there are some benefits that will kick in in six months now that it is signed into law.
For one, insurance companies will be prohibited from denying coverage to children who have a pre-existing condition. Young adults can remain on their parents' health insurance plans until they are 26 years old. Individuals who are uninsured and have a pre-existing condition can now obtain health insurance through a new program that expires when the new insurance exchanges open in 2014.
The bill Obama signed into law does not include a "public option" or government-run plan to compete with private insurers. The proposal was included in the Senate bill the House voted on last year, but stripped from the final bill at the urging of the White House so the measure would win the support of conservative Blue Dog Democrats whose votes were cruical in order to ensure the legislation passed.
Meanwhile, three far-right lawmakers - Reps. Michelle Bachmann (R-Minnesota) and Steve King (R-Iowa) and Sen. Jim DeMint (R-South Carolina) - said they will introduce legislation to repeal the bill, a measure that does not have the votes to pass and one that Obama would never sign even if it did.
Just minutes after Obama signed the legislation into law, attorneys general from 13 states filed a lawsuit in Pensacola, Florida against the federal government, alleging the health care bill is unconstitutional. The lawsuit says "the Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage."
Bill McCollum, Florida's Attorney General, is leading the fight and has the support of attorneys general from South Carolina, Nebraska, Texas, Michigan, Utah, Pennsylvania, Alabama, South Dakota, Idaho, Washington, Colorado and Louisiana. The only Democratic attorney general who joined the 12 Republicans is James Caldwell of Louisiana.
"We are convinced that this legislation is fundamentally flawed as a matter of constitutional law, that it exceeds the scope of proper constitutional authority of the federal government and tramples upon the rights and prerogatives of states and their citizens," said David Rivkin, Jr., a former Justice Department official who worked in the administration of former President George H.W. Bush and is representing 13 of the states.
Still, McCollum said he's confident “that at the end of the day, the United States Supreme Court is going to declare this health care bill unconstitutional.”
"To that I say, 'Bring it on,'" said White House domestic policy chief Melody Barnes, who cited similar suits filed over Social Security and the Voting Rights Act when those were passed. "If you want to look in the face of a parent whose child now has health care insurance and say we're repealing that ... go right ahead."
A new USA Today/Gallup poll released Tuesday found a majority of Americans view the health care bill favorably.
"By 49%-40% those surveyed say it was 'a good thing' rather than a bad one that Congress passed the bill," USA Today reported. "Half describe their reaction in positive terms, as'"enthusiastic' or 'pleased,' while about four in 10 describe it in negative ways, as 'disappointed' or 'angry.'
"The largest single group, 48%, calls the bill 'a good first step' that should be followed by more action on health care. An additional 4% also have a favorable view, saying the bill makes the most important changes needed in the nation's health care system."