President Barack Obama celebrates the crowning achievement of his presidency Tuesday as he signs into law a massive health care overhaul bill that had been seen as dead just two months ago. That, however, will not end America's raging debate over the legislation.
Republicans unanimously oppose the measure, calling it a costly government takeover of health care that would raise taxes. The issue has stirred the passions of Americans on both sides of the debate.
Democrats argue that they have delivered on Obama's campaign pledge for change, revamping a system in which the spiraling costs have put health care and insurance out of reach of Americans.
After Obama signs the bill in a White House ceremony, Senate Democrats will try to push through a companion bill revising the plan — part of the complicated two-step process needed to get the overhaul through Congress. Republicans will try to derail the legislation, but, ultimately, Democrats are likely to succeed.
Debate to continue
Yet even then, the health care debate will likely continue for months as both parties try to use it to motivate their backers to turn out in huge numbers in the November congressional elections. Republicans hope the polarizing issue will help them retake Congress from the Democrats.
Obama's year-long campaign to overhaul health care seemed at a dead end in January, when Republicans won a special election to fill the late Edward Kennedy's Massachusetts Senate seat, and with it, enough votes to prevent a final vote. But the Democrats regrouped, and persuaded enough House members to pass it with a procedure that did not require a supermajority in the Senate.
Republicans will accuse Democrats of steamrolling into law a plan they say lacks public support and will lead to high taxes and government meddling in personal health decisions. They have already begun a campaign to repeal it, though that will be largely symbolic because it would require a Republican president with a two-thirds Republican majority in the Senate.
The bill, passed by the House of Representatives on Sunday night, will bring near-universal coverage to a wealthy country in which tens of millions of people are uninsured. It makes Obama the first president to succeed in passing comprehensive health care reform since Teddy Roosevelt championed the cause a century ago.
The measure represents the biggest expansion of the U.S. federal government's social safety net since the 1960s, when President Lyndon B. Johnson enacted the Medicare and Medicaid government-funded health care coverage programs for the elderly and poor.
Although the bill does not provide universal health care, it should expand coverage to about 95 percent of eligible Americans, compared with 83 percent today.
Obama has pushed health care as his top priority since taking office in January 2009. Failure would have weakened him and endangered other issues on the president's ambitious domestic agenda, including immigration reform and climate change legislation.
The Senate-passed bill cleared the House on Sunday night on a 219-212 vote, with Republicans unanimous in opposition.
A second, smaller measure — making changes in the first — cleared the House shortly before midnight and was sent to the Senate, where Democratic leaders said they had the votes necessary to pass it quickly.
Remaking nation’s health care system
Obama is expected to sign the bill Tuesday at the White House, spokesman Robert Gibbs said Monday. That will cap a turbulent quest by the president and congressional Democrats to remake the country's health care system, fully one-sixth of the U.S. economy.
Obama will go to the state of Iowa on Thursday for a public event as he now turns to seeing the companion bill through the Senate and selling the health care overhaul's benefits on behalf of House lawmakers who cast risky votes.
States are already lining up to sue the federal government over the constitutionality of the health care overhaul legislation. Officials in at least 10 states have agreed to file a lawsuit challenging it on grounds it violates state sovereignty by mandating that all Americans have some form of health insurance. Experts say the effort will likely fail because the Constitution states that federal law supersedes state laws, but it will keep the issue, and the outrage, alive until Election Day.
Sunday's debate in the House was rancorous. Some Republicans say the bill will help fund abortions, even though Obama will sign an executive order barring that from happening. Texas Republican Rep. Randy Neugebauer acknowledged Monday that he shouted out "baby killer" during a floor speech by Rep. Bart Stupak, an anti-abortion Democrat whose vote was crucial to passing the Democratic health care bill Sunday evening. Neugebauer said he had apologized to Stupak for his outburst, which drew a rebuke from the chair.
‘All this euphoria going on’
Republican Senator 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."
Not one Republican voted for the bill. Some moderate Democrats also voted against it.
Most Americans receive private health insurance through their jobs as part of their benefits, but employers are not required to offer coverage. The government covers the elderly and indigent.
The health reform measure extends coverage to 32 million of the nearly 50 people in the U.S. who lack it and bans insurers from denying coverage on the basis of pre-existing medical conditions. It would also usher in a significant expansion of Medicaid, the program for the poor.
Parents would be able to keep children on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.
For the first time, most Americans would be required to purchase insurance, and face penalties if they refused.
A majority of working-age Americans and their families will still have employer-sponsored coverage. But the number of uninsured will drop by more than half. Illegal immigrants would account for more than one-third of the remaining 23 million people without coverage.