A transformative health care bill is headed to President Barack Obama for his signature as Congress takes the final steps in Democrats' improbable and history-making push for near-universal medical coverage.
On the cusp of succeeding where numerous past congresses and administrations have failed, jubilant House Democrats voted 219-212 late Sunday to send legislation to Obama that would extend coverage to 32 million uninsured Americans, reduce deficits and ban insurance company practices such as denying coverage to people with pre-existing medical conditions.
"This is what change looks like," Obama said later in televised remarks that stirred memories of his 2008 campaign promise of "change we can believe in."
"We proved that this government - a government of the people and by the people - still works for the people."
Obama will travel outside Washington on Thursday as he now turns to seeing a companion bill through the Senate and selling the health care overhaul's benefits on behalf of House lawmakers who cast risky votes. It is most likely that he will sign the bill on Tuesday, but the plans are not yet final, said a senior administration official, who spoke on condition of anonymity to discuss as-yet unannounced strategy.
Obama's young presidency received a much needed boost from passage of the legislation, which would touch the lives of nearly every American. The battle for the future of the health insurance system - affecting one-sixth of the economy - galvanized Republicans and conservative activists looking ahead to November's midterm elections.
A companion package making a series of changes sought by House Democrats to the larger bill, which already passed the Senate, was approved 220-211. The fix-it bill will now go to the Senate, where debate is expected to begin as early as Tuesday. Senate Democrats hope to approve it unchanged and send it directly to Obama, though Republicans intend to attempt parliamentary objections that could change the bill and require it to go back to the House.
Sen. John McCain said Monday morning that Democrats have not heard the last of the health care debate, and said he was repulsed by "all this euphoria going on."
Appearing on ABC's "Good Morning America," McCain, who was Obama's GOP rival in the 2008 presidential campaign, said that "outside the Beltway, the American people are very angry. They don't like it, and we're going to repeal this."
McCain, who is in a tough Republican primary fight in his home state, said the GOP "will challenge it every place we can," and said there will be reprisals at the polls, in Congress and in the courts.
The complicated two-step approval process was made necessary because Senate Democrats lost their filibuster-proof supermajority in a special election in January, a setback that caused even some Democratic lawmakers to pronounce the yearlong health care effort dead. Under the relentless prodding of House Speaker Nancy Pelosi, in particular, it was gradually revived, and the fix-it bill will be considered under fast-track Senate rules that don't allow minority party filibusters.
"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans," said Pelosi, D-Calif., partner to Obama and Senate Majority Leader Harry Reid in the grueling campaign to pass the legislation.
"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.
GOP lawmakers attacked the legislation as everything from a government takeover to the beginning of totalitarianism, and none voted in favor. "Hell no!" Minority Leader John Boehner, R-Ohio, shouted in a fiery speech opposing the legislation. "We have failed to listen to America and we have failed to reflect the will of our constituents."
Thirty-four Democrats also voted "no" on the Senate-passed bill.
Sunday night's votes capped an unpredictable and raucous weekend at the capitol, with Democratic leaders negotiating around the clock for the final votes as hundreds of protesters paraded outside, their shouts of "Kill the Bill! Kill the Bill!" audible within the Capitol.
A last-minute deal with a critical group of anti-abortion lawmakers Sunday afternoon sealed Democrats' victory. The leader of the anti-abortion bloc, Rep. Bart Stupak, D-Mich., didn't get to add stricter anti-abortion language to the underlying bill, but was satisfied by an executive order signed by Obama affirming current law and provisions in the legislation that ban federal funding for abortions except in cases of rape, incest or danger to the life of the mother.
Republican abortion foes said Obama's proposed order was insufficient, and when Stupak sought to counter them, a shout of "baby killer" was heard coming from the Republican side of the chamber.
Far beyond the political ramifications - a concern the president repeatedly insisted he paid no mind - were the sweeping changes the bill held in store for Americans, insured or not, as well as the insurance industry and health care providers.
The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would cut deficits by an estimated $138 billion over a decade. For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.
The second measure, which House Democrats demanded before agreeing to approve the first, included enough money to close a gap in the Medicare prescription drug coverage over the next decade, starting with an election-season rebate of $250 later this year for seniors facing high costs.
It also included sweeping changes in the student loan program, an administration priority that has been stalled in the Senate for months.
For the president, the events capped an 18-day stretch in which he traveled to four states and lobbied more than 60 wavering lawmakers in person or by phone to secure passage of his signature domestic issue. He also postponed an overseas trip to remain in Washington and push for the bill.
Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and dozens of aides, exchanged high fives with Rahm Emanuel, his chief of staff, and then telephoned Pelosi with congratulations.
Now Obama will have to sell the bill to the public, and a White House aide said he was likely to take at least one trip this weekend to emphasize the legislation's benefits.
The measure would also usher in a significant expansion of Medicaid, the federal-state health care program for the poor. The insurance industry, which spent millions on advertising trying to block the bill, would come under new federal regulation. Parents would be able to keep children up to age 26 on their family insurance plans.
To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade and cuts more than $500 billion from planned payments to hospitals, nursing homes, hospices and other providers that treat Medicare patients.