By Richard Wolf and John Fritze
A day after jubilant House Democrats pushed through historic legislation to extend health care coverage to 32 million uninsured Americans, President Obama turned his attention Monday to getting a companion bill through the Senate and selling the benefits to the public.
Obama will sign the first bill Tuesday at the White House, spokesman Robert Gibbs said. He said Obama is inviting all lawmakers who supported the bill and other people whose stories reflect the need for the bill.
The president will travel to Iowa City on Thursday, part of his continuing effort to sell the bill to a divided public. Meanwhile, a companion bill making a series of changes sought by House Democrats was sent to the Senate, where debate could begin Tuesday.
Some Republicans have already promised to make repeal of the legislation a major theme of the 2010 campaign year, and beyond. Sen. John McCain, R-Ariz., said Monday on ABC's Good Morning America that "we are going to try to repeal this. And we are going to have a very spirited campaign coming up between now and November."
Lawyers for both sides are gearing up. Legal challenges could focus on parts of the health care bill, such as its requirement that all Americans buy health insurance or face financial penalties. Said McCain: "We'll challenge it every place we can."
Victorious Democats were gleeful after the vote late Monday night.
"Today, we have the opportunity to complete the great unfinished business of our society and pass health care reform for all Americans that is a right and not a privilege," House Speaker Nancy Pelosi of California said in the final floor speech before the vote on the 10-year, $940 billion plan.
Democrats who provided all 219 votes cheered "Yes we can" when the needed votes were cast, assuring that about 32 million Americans will gain health insurance coverage and millions more will win protections against losing theirs. The legislation will raise taxes, largely on the wealthy, and reduce future Medicare spending by about $500 billion.
It gave Obama a major victory and will make him, at least for now, a more powerful president who made good on his campaign promise of change.
"We proved that we are still a people capable of doing big things," Obama said in statement delivered after the House votes with Vice President Biden at his side. "We proved that this government, a government of the people and by the people, still works for the people."
Republicans who voted unanimously against the health care overhaul, along with 34 Democrats, predicted it would come back to bite Democrats at the polls -- and in the form of repeal efforts as soon as next year.
"Just because it's historic doesn't mean it's good," said Rep. Peter Roskam, R-Ill.
In his closing argument, House Republican leader John Boehner of Ohio thundered that the Democrats were ignoring the will of the people.
"We have failed to listen to America, and we have failed to reflect the will of our constituents," he said. "And when we fail to reflect that will, we fail ourselves, and we fail our country."
With every Republican poised to vote "no," Pelosi and her leadership team had to a strike a late deal on abortion language with some of the party's conservative members.
In a dramatic turn, eight anti-abortion Democrats, led by Rep. Bart Stupak, D-Mich., announced late Sunday afternoon that they would support the bill even though it did not include stronger prohibitions against using federal money to cover abortions -- a move that gave Obama the votes he needed to pass the bill. Instead, the conservative lawmakers settled for an executive order signed by Obama.
"We would all love to have a statute that is stronger," Stupak said. "We can't get there."
Determined not to fail where their party has so many times before, most recently in 1994, Democratic leaders drew on history as they marched toward passage of the legislation.
"This will be one of those events that every textbook writer is going to have to put in his books," said presidential scholar William Leuchtenburg, author of Franklin D. Roosevelt and the New Deal.
After more than a year of debate, including heated summer town-hall meetings and an icy winter summit between Obama and Republicans, Democrats had to go it alone.
"It's not the desirable way to enact major social policy, but it might be the only way," said Robert Reischauer, president of the nonpartisan Urban Institute and a former Congressional Budget Office director.
Polls continue to show Americans split down the middle on the issue, and both sides claim momentum.
"The opposition to this is as strong as it was in July," said R. Bruce Josten, executive vice president for government affairs at the U.S. Chamber of Commerce, which spent $145 million lobbying last year, much of it on health care. "Americans are not being fooled by this."
Many Americans, particularly those with private insurance from their employers, remained in the dark about whether the overhaul would help or hurt -- even the grandson of President Harry Truman, who fought for universal health care more than a half century ago.
"How much damage is this going to do? How good a bill is this going to be?" said Clifton Truman Daniel, public relations director at the Harry S Truman College in Chicago. "My assumption is that it will improve things, but who knows?"
Throughout the rare weekend session, Democratic leaders repeatedly tried to frame the debate as part of a much larger, historic effort to revamp health care, while reducing the nation's deficit by $143 billion over the first 10 years.
House Rules Committee Chairwoman Louise Slaughter of New York held up a 1939 letter from President Franklin Delano Roosevelt to Congress seeking expanded health coverage as part of Social Security. The letter had FDR's notes in the margins.
Pelosi appeared at a news conference with the same gavel Rep. John Dingell, D-Mich., used to end the House debate on the Medicare legislation 45 years ago -- and she vowed to use it at the end of Sunday's vote.
"We're doing this one for the American people," Pelosi said.
As Democrats put on a confident face, they could not escape the controversies that the health care plan continues to stir. As Pelosi finished her remarks after a meeting of House Democrats, 66-year-old Ron Arner of Pennsylvania shouted, "You're doing it to the American people."
Around the corner, Arner started shouting down Rep. Barney Frank, D-Mass., as he spoke to a reporter. "This is Fox News," Frank quipped, suggesting that Arner might not want to interrupt the cable network because it is perceived as conservative.
Republican House members stood on a second-floor balcony and waved to a crowd of about 1,000 protesters gathered on the National Mall. Several of them unfurled a yellow flag that read, "Don't tread on me," prompting loud cheers.
"That was fun," Rep. Mary Fallin, R-Okla., said as she walked back into the Capitol.
The opposition will have one more shot in the Senate, which must vote on the changes demanded by Obama and House Democrats as the price of passing the Senate health care bill. Republicans, led by Senate Minority Leader Mitch McConnell of Kentucky, plan scores of amendments and procedural challenges.
If the Senate parliamentarian decides any part of the second bill must be struck because it does not, as required, have fiscal implications, the measure would have to go back to the House. And a "vote-o-rama" on Republicans' amendments could go on for days.
The second bill also includes an overhaul of the college aid program that would give the government -- not private lenders -- the power to authorize all Pell Grant loans for needy students.
Nearly lost in Sunday's focus on protests, process and politics was the stunning array of new federal policies included in the legislation. Dingell, 83, who succeeded his father in the House 55 years ago, called it a natural successor to Medicare.
"We were solving an enormous problem, the health concerns of the elderly in this country," he said of that vote 45 years ago. "Today, we are doing what we intended to be the second step, and that is addressing the health concerns and the health problems of all of the people. Unfortunately, it's been a very slow national progression."
The package of changes would provide coverage to 32 million people through Medicaid, subsidies to families and tax credits to small businesses that can't afford to cover their workers. It would pay for the expansion with the Medicare cuts, new taxes on upper-income workers and expensive insurance plans, and fees on the manufacturers of prescription drugs and medical devices.
It also would prohibit insurers from denying coverage based on pre-existing conditions, dropping people when they get sick and limiting lifetime benefits. Children could be covered on their parents' policies up to age 26, and seniors would receive improved coverage for Medicare prescription drugs. Most individuals would be required to have insurance, and businesses with 50 or more employees would have to provide it or pay a fee.
Faced with all those provisions and more, Washington's lobbying industry has weighed in with full force. The number of corporations, trade associations and other organizations that disclosed their efforts on health care grew from 398 during the first months of 2009 to 1,541 by the end of the year. Health professionals and health insurers spent more than $576 million on lobbying, up from $515 million in 2008 and $210 million a decade ago.
In the end, most stakeholders endorsed Obama's plan, including major trade groups representing doctors, hospitals, pharmaceutical companies and the AARP, the nation's largest seniors' organization. Two groups -- the U.S. Chamber of Commerce and America's Health Insurance Plans -- opposed it with multimillion dollar ad campaigns.
Karen Ignagni, president of the insurers' trade group, expressed regret that Obama in recent weeks decided to "villainize" her industry for premium increases necessitated by rising medical costs, which she said the legislation mostly fails to address. Access is "a very important step forward," she said. "But the cost crisis needs to be addressed."
"My members are sitting there looking at cost, cost, cost, tax, tax, tax," the Chamber's Josten said.
The taxes will fall heaviest on upper-income taxpayers, according to an analysis by Deloitte Tax. It found that single taxpayers earning $250,000 a year would pay $450 more in Medicare payroll taxes, for instance. Those earning $500,000 would pay $2,700 more, while those earning $1 million would pay $7,200 more. Those with income of $5 million would pay $43,200 more.
It will take years to sort out winners and losers among consumers, insurers and health care providers.
Some of the law's provisions, such as a tax on the most expensive insurance plans, don't take effect for nearly a decade.
The political consequences will be known much sooner. Republicans hope to defeat dozens of Democrats this fall, and health care represents "a bigger vote than anything we've already had," says Rep. Pete Sessions, who runs the National Republican Congressional Committee.
Democratic leaders predicted the measure would become more popular after it passes, giving those who voted for it time to herald some of the changes that would be made later this year. Among them: $250 rebates for seniors to help pay the costs of prescription drugs.
"If the Republicans want to make November all about the repeal of this bill, I don't quote George Bush very often, but 'bring it on,' " said Rep. Chris Van Hollen, chairman of the Democratic Congressional Campaign Committee.
One thing most experts agree on: Obama needed to win.
Fred Greenstein, director of the program in leadership studies at Princeton's Woodrow Wilson School, said Obama's image will be recast from "a cerebral wimp who can't hack it and doesn't have spine and doesn't understand Machiavelli's principle that it's better to be feared than loved. Instead, he's suddenly looking very good."
David Abshire, president of the Center for the Study of the Presidency and Congress and a former NATO ambassador, said defeat "would be a terrific blow to his presidency, and it would be a symbol around the world that his power is broken."
Representatives who changed votes
A sampling of House lawmakers who said going into debate on Sunday that they would switch their votes on health care.