Image: Nancy Pelosi
Susan Walsh  /  AP
House Speaker Nancy Pelosi of Calif., with Democratic leaders and guests, holds the recently signed Health Care and Education Reconciliation Act.
updated 3/26/2010 12:28:12 PM ET 2010-03-26T16:28:12

Congressional Democrats on Friday sent the final piece of landmark health care legislation to President Barack Obama, the last legislative chapter in the wrenching national debate over how to overhaul America's health care system.

The House of Representatives on Thursday night approved — for the second time — a package of fixes to the sweeping bill Obama signed two days before. The measure includes better benefits for seniors and low-income and middle-class families.

Thursday's vote was 220-207, as majority Democrats prevailed despite 32 defections, and no Republican support. The same bill had passed the Senate earlier in the day 56-43, with all voting Republicans and three Democrats voting "no."

Obama was expected to sign the measure early next week.

"This makes a tremendous difference in the lives of Americans," House Speaker Nancy Pelosi, a Democrat, said at a congressional ceremony Friday. House Republican leader Rep. John Boehner bitterly opposed the overhaul to the end, called it a "grim moment for millions."

Lawmakers were heading home for a spring recess to face a skeptical — and sometimes even threatening — electorate. The health care reform also promises to be a key issue in November congressional elections.

Obama has taken to the road to promote the health care reform, in part to help his party's chances of holding onto its majority in both chambers of Congress.

"We made a promise. That promise has been kept," Obama told a crowd in the Midwestern state of Iowa on Thursday.

"From this day forward, all of the cynics, all the naysayers — they're going to have to confront the reality of what this reform is and what it isn't," the president said. "They'll have to finally acknowledge this isn't a government takeover of our health care system."

Taken together, the two bills extend coverage to 32 million uninsured Americans and aim to crack down on unpopular insurance industry practices such as denying coverage for people with pre-existing medical conditions and to reduce federal deficits by an estimated $143 billion over a decade.

The United States has been the only developed nation that lacked a comprehensive health care system. Many Americans rely on employer-subsidized coverage, which became increasingly precarious during the recession, as millions lost jobs and with it their family's health coverage.

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Timeline: How the health overhaul bill passed Most Americans would now be required to buy insurance, or face penalties if they refused.

In the hours ahead of Thursday's vote, lawmakers reported isolated threats of violence.

At least 10 Democrats now have reported harassment, including incidents involving at least four of their offices in New York, Arizona and Kansas. An undisclosed number of lawmakers have been given increased police protection.

The fix-it bill was slightly changed by the Senate from a version that passed the House last weekend, necessitating Thursday night's second vote by the House because both chambers must approve identical legislation before the president can sign it.

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Video: Pelosi turns 70, calls bill 'a gift'

  1. Closed captioning of: Pelosi turns 70, calls bill 'a gift'

    >>> back during the cold war .

    >>> turning now to health care reform . president obama will sign the final version of the health care bill on tuesday. today speaker of the house nancy pelosi put her signature on it. after that, her staff then brought out a rather large birthday cake to mark the speaker's 70th birthday today.

    >>> one of the things the


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