President Obama signed a landmark health insurance overhaul Tuesday in a ceremony that put the finishing touch on a yearlong battle that has defined his presidency.
The president, pausing to take in the cheers and applause from the room full of congressional Democrats, Cabinet secretaries and supporters, said the signing marks a "new season in America."
He called the completion of the bill both “remarkable and improbable,” an acknowledgement of the hurdles and stiff opposition his health care push endured as well as the succession of past presidents and Congresses that have tried to pass a national health care overhaul.
Obama described the passage of the bill as a testament to America’s greatness.
“We are not a nation that scales back its aspirations. We are not a nation that falls prey to doubt or mistrust. … Here in this nation, we shape our own destiny,” Obama said.
In a shot at critics, Obama said the "overheated rhetoric" would finally meet the "reality of reform."
The president will turn next to championing the controversial bill's contents to the public, while tackling major issues -- like the economy -- that slipped to the backburner during the health care debate and trying to save his party from a backlash at the polls in November.
The next act begins Thursday, when Obama visits Iowa City, Iowa, where he announced his health care plan as a presidential candidate in May 2007. There Obama plans to talk about how the new law will help lower health care costs for small businesses and families, selling the overhaul to Americans who are deeply divided over the plan.
The ceremony Tuesday in Washington was triumphant. Biden introduced the president by extensively praising Obama’s perseverance and putting the moment in broad historical context.
“You’ve done what generations … of great men and women have attempted to do,” Biden said. “They fell short. … You delivered on a promise.”
Biden punctuated his point with some profanity at the end, whispering, “This is a big f---ing deal,” in the president’s ear loud enough for the microphones to pick it up at the podium.
“Thank you, Joe,” Obama said, as calmed the room down and started his remarks.
The House narrowly passed the Senate's health insurance overhaul Sunday night, 219-212, but Congress is still considering a package of changes that House Democrats sought to bring the bill more in line with their original piece of legislation.
Whether or not that bill is passed, the bill Obama signed Tuesday will making sweeping changes to the nation's health care system over the next several years -- setting restrictions on insurance companies, providing billions in subsidies to help Americans buy coverage and forcing people for the first time nationally to buy health insurance.
"The bill I'm signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see," Obama said.
But Republicans united in opposition pledged to repeal Obama's redesign of the health care system, which they criticized as a costly government takeover impacting one-sixth of the U.S. economy.
Moments after Obama signed the bill, Florida Attorney General Bill McCollum filed a lawsuit, which he’s joining with 10 other state attorneys general, challenging the constitutionality of the bill.
Tea Party activists who believe that government spending and influence should be limited say they are angry about the new bill and vowed to extract political revenge on those who passed it.
The government "has declared war on our way of life," activist Eric Odom from Nevada said Monday. "It's now time to boot them from office."
After a rancorous debate, the House voted 219-212 late Sunday to send the 10-year, $938 billion bill to Obama. Not one Republican voted for the bill. Thirty-four Democrats also voted against it.
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 says he has the votes to pass it -- though only under special budget rules requiring just 50 votes.
Republicans plan 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.
Even so, 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.
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 two-thirds Republican majority in the House and Senate to overcome an Obama veto.
Obama's yearlong campaign to overhaul health care seemed at a dead end in January, when Republican Scott Brown won a special election to fill the Massachusetts seat held by the late Edward Kennedy, and with it, enough votes to prevent the bill from coming to a final vote in the Senate.
But the Democrats regrouped, and relentless prodding by House Speaker Nancy Pelosi persuaded enough House members to pass it with a procedure that did not require a 60-vote supermajority 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.
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. However, success does not bode well for future cooperation on those issues by beleaguered lawmakers.
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.
A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. The companion bill includes an election-year rebate of $250 later this year for seniors facing high costs for prescription drugs.
By 2014, most Americans will for the first time be required to carry insurance -- either through an employer, a government program or by buying it for themselves. Those who refuse will face penalties from the Internal Revenue Service.
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 the state-federal Medicaid program will be expanded to cover more low-income people.
The Associated Press contributed to this report.