President Barack Obama is poised to sign the landmark health care bill ushering in near-universal medical coverage for the first time in the nation's history—and then he'll hit the road to resume selling it to a reluctant public.
Obama will travel to Iowa City, Iowa, on Thursday, the White House said, as he turns to seeing a companion bill through the Senate and talking up the overhaul's benefits on behalf of House members who cast risky votes.
Obama is expected to sign the bill Tuesday at the White House, spokesman Robert Gibbs said Monday. A South Lawn ceremony is planned. Obama is inviting all lawmakers who supported the bill and other Americans whose stories represent the need for reformed health care, Gibbs said.
"Last night we made history," House Speaker Nancy Pelosi, D-Calif., told reporters as she signed the legislation, a formality before Obama's own signature. "It's on a par with passing Social Security and Medicare."
The House voted 219-212 late Sunday to send the legislation to Obama. The 10-year, $938 billion bill would extend coverage to 32 million uninsured Americans, reduce deficits and ban insurance company practices such as charging more to women and denying coverage to people with medical problems.
"This is what change looks like," Obama said after the vote, a remark echoing his 2008 campaign promise of "change we can believe in."
"We proved that this government—a government of the people and by the people—still works for the people."
Obama's young presidency received a much needed boost from passage of the legislation, which would touch the lives of nearly every American. The battle for the future of the health insurance system—affecting one-sixth of the economy—galvanized Republicans and conservative activists looking ahead to November's midterm elections.
A companion package making a series of changes sought by House Democrats to the main bill, which already had passed the Senate, was approved 220-211. The fix-it bill will now go to the Senate, where debate is expected to begin as early as Tuesday.
Senate Democrats hope to approve it unchanged and send it directly to Obama, though Republicans plan parliamentary objections that could change the bill and require it to go back to the House.
Sen. John McCain said Monday morning that Democrats have not heard the last of the health care debate, and said he was repulsed by "all this euphoria going on."
Appearing on ABC's "Good Morning America," McCain, who was Obama's GOP rival in the 2008 presidential campaign, said that "outside the Beltway, the American people are very angry. They don't like it, and we're going to repeal this."
The complicated two-step approval process for the legislation was made necessary because Senate Democrats lost their filibuster-proof supermajority in a special election in January, a setback that caused even some Democratic lawmakers to pronounce the yearlong health care effort dead. Under the relentless prodding of Pelosi, in particular, it was gradually revived, and the fix-it bill will be considered under fast-track Senate rules that don't allow minority party filibusters.
"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans," said a jubilant Pelosi, D-Calif., partner to Obama and Senate Majority Leader Harry Reid in the grueling campaign to pass the legislation.
"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.
GOP lawmakers attacked the legislation as everything from a government takeover to the beginning of totalitarianism, and none voted in favor. "Hell no!" Minority Leader John Boehner, R-Ohio, shouted in a fiery speech. "We have failed to listen to America and we have failed to reflect the will of our constituents."
Thirty-four Democrats also voted "no" on the Senate-passed bill.
Sunday night's votes capped an unpredictable and raucous weekend at the capitol, with Democratic leaders negotiating around the clock for the final votes as hundreds of protesters paraded outside, their shouts of "Kill the Bill! Kill the Bill!" audible within the Capitol.
A last-minute deal with a critical group of anti-abortion lawmakers Sunday afternoon sealed Democrats' victory. The leader of the anti-abortion bloc, Rep. Bart Stupak, D-Mich., didn't get to add stricter anti-abortion language to the underlying bill, but was satisfied by an executive order signed by Obama affirming current law and provisions in the legislation that ban federal funding for abortions except in cases of rape, incest or danger to the life of the mother.
Republican abortion foes said Obama's proposed order was insufficient.
Far beyond the political ramifications—a concern the president repeatedly insisted he paid no mind—were the sweeping changes the bill held in store for Americans, insured or not, as well as for the insurance industry and health care providers.
The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would cut deficits by an estimated $143 billion over a decade. For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.
The second measure, which House Democrats demanded before agreeing to approve the first, included enough money to close a gap in the Medicare prescription drug coverage over the next decade, starting with an election-season rebate of $250 later this year for seniors facing high costs.
It also included major changes in the student loan program, an administration priority that has been stalled in the Senate for months.