A broadly smiling President Barack Obama on Tuesday signed a historic $938 billion health care overhaul that guarantees coverage for 32 million uninsured Americans and will touch nearly every citizen's life, presiding over the biggest shift in U.S. domestic policy since the 1960s and capping a divisive, yearlong debate that could define the November elections.
Celebrating "a new season in America" - the biggest accomplishment of his White House and one denied to a line of presidents before him - Obama made the massive bill law with an East Room signing ceremony.
He was joined by jubilant House and Senate Democrats as well as lesser-known people whose health care struggles have touched the president.
Obama scheduled back-to-back events to mark the moment, with much of his White House audience, as well as hundreds of others, heading to the Interior Department immediately after the signing.
"Today after almost a century of trial, 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. Today," Obama said, interrupted by applause after nearly every sentence. "All of the overheated rhetoric over reform will finally confront the reality of reform."
Obama waited well over a year for the moment, and he'll follow it up Thursday with a trip to Iowa to talk it up.
With Victoria Kennedy, widow of the late Sen. Edward Kennedy in the audience, Obama took note of the long battle to bring the health overhaul measure to his desk.
Participants chanted "Fired up, ready to go," as Obama appeared, smiling broadly.
The elaborate White House signing ceremony kicks off the next act: selling the sweeping changes to a skeptical public.
The White House did everything possible to make sure Obama's health care victory lap carried the day with no competition.
A planned announcement of the administration's new drug control policy by Vice President Joe Biden was called off, White House press secretary Robert Gibbs declined to hold his regular daily briefing for reporters and all Obama's meetings were closed to coverage, including one with Israeli Prime Minister Benjamin Netanyahu.
Act II begins Thursday when Obama visits Iowa City, Iowa, where as a presidential candidate he announced his health care plan in May 2007, to talk about how it will help lower health care costs for small businesses and families.
The House late Sunday voted 219-212 - no Republicans voted in favor - to send the 10-year, $938 billion bill to Obama.
The measure, which the Senate passed in December, eventually will extend coverage to 32 million uninsured Americans, reduce federal budget deficits and ban such insurance company practices as denying coverage to people with existing medical problems.
A companion measure sought by House Democrats to make a series of changes to the main bill was approved 220-211. It goes to the Senate, where debate could begin as early as Tuesday. Majority Leader Harry Reid, D-Nev., says he has the votes to pass it - though only under special budget rules requiring just a simple majority vote.
Republicans are united in opposition to Obama's redesign of the health care system, and are assailing it as an unwarranted government takeover, threatening a move to repeal it.
In the Senate, the GOP plans to offer scores of amendments to slow or change the companion measure, which Democrats hope to approve as written and send directly to Obama for his signature.
Within six months of enactment of the bill - or by the end of September - consumers should notice some changes. Among them, insurers would be required to keep young adults as beneficiaries on their parents' health plans until they turn 26, and companies would no longer be allowed to deny coverage to sick children.
Other changes would not kick in until 2014.
By then, most Americans will for the first time be required to carry health insurance - either through an employer, through a government program or by buying it for themselves. Those who refuse will face penalties from the IRS.
Tax credits to help pay for premiums also will start flowing to middle-class working families with incomes up to $88,000 a year, and Medicaid will be expanded to cover more low-income people.
The nonpartisan Congressional Budget Office said the bill awaiting Obama's signature would cut federal budget deficits by an estimated $143 billion over a decade.
The second measure, which House Democrats demanded before agreeing to approve the first one, includes enough money to close a gap in Medicare prescription drug coverage over the next decade, starting with an election-year rebate of $250 later this year for seniors facing high costs.
Polls show the public is split over the bill, so Obama will stick with the sales job for the foreseeable future, with an eye toward helping those Democrats who cast risky votes for his plan and who are facing tough re-election battles in November.
(Copyright 2010 by The Associated Press. All Rights Reserved.)