WASHINGTON -- Congressional Democrats sent the final piece of landmark health care legislation to President Barack Obama before heading home for a spring recess to face a skeptical -- and sometimes even threatening -- electorate.
The last legislative chapter in the wrenching national debate over Obama's health reform plan came Thursday night in the House of Representatives, as Democrats 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.
In Iowa to trumpet the benefits of the legislation, Obama said, "We made a promise. That promise has been kept."
"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.
America was 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.
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 from a volatile public.
The 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.
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.
"This is the last step we must take to make health reform a reality for millions of Americans," said Rep. Frank Pallone, a Democrat from New Jersey.
Republicans were bitterly opposed to the end.
"We need to repeal Obamacare and replace it with policy that will create more access, create jobs, which will lower the cost of health care and not be a government takeover of the health care system," said Rep. Paul Broun, a Republican from Georgia.
The second of the two bills also presented Obama with another victory, stripping banks and other private lenders of their ability to originate student loans in favor of a system of direct government lending.
After a months-long battle in Congress, the political struggle was morphing into a new phase in which public debate was tinged with violence -- and politicians accused one another of seeking to exploit it for their own advantage. It added up to a charged atmosphere for lawmakers about to head back to their home districts for the two-week Easter and Passover recess.
More than 10 lawmakers in the House said they had received threats or worse as a consequence of the health care debate, most of them Democrats who voted in favor of the legislation. There were reports of bricks through windows, a cut propane line to a grill and numerous obscene and threatening phone calls, letters and faxes. An undisclosed number of lawmakers were under increased police protection.
Democratic House Speaker Nancy Pelosi and the Republican leader, Rep. John Boehner, both denounced the threats and incidents of violence. But Democrats said Republicans had been too slow to respond, drawing an outraged response in return.
Thursday's votes marked the final stages of a rescue mission that Obama and Democratic leaders mounted more than two months ago, after Republicans unexpectedly won a Massachusetts Senate seat, and with it, the ability to slow final action on health care legislation.
Under a revised strategy, the House agreed to approve a Senate-passed bill despite numerous objections, on the condition that both houses would follow quickly with a fix-it measure. The one finally brought to a vote on Thursday added more than $20 billion to subsidies for lower- and middle-income individuals and families who will be required to purchase insurance, and about $8 billion over a decade for states that already provide more generous than average Medicaid benefits.