WASHINGTON — President Barack Obama on Tuesday signed into law a vast overhaul of the nation's health care system, the most sweeping expansion of government social policy in more than 40 years, and perhaps the most polarizing.
A triumphant Obama heralded what he called "a new season in America," saying that the new law finally delivered changes in health care that generations of Americans had sought and fought for.
"Our presence here today is remarkable and improbable," Obama said. "It’s been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve."
Now, however, he said, "we are affirming that essential truth — a truth every generation is called to rediscover for itself — that we are not a nation that scales back its aspirations."
The president signed the Patient Protection and Affordable Care Act cheered on by Democratic lawmakers as well as Vicki Kennedy, the widow of the late Sen. Edward Kennedy, D-Mass., who'd made the expansion of health care his life's work.
Supporters interrupted several times with applause and campaignlike chants, turning the ceremony into a celebration. Even before Obama walked in, a group of Democratic women from Congress lined up on the stage to pose for pictures. Others broke into chants of the Obama campaign refrain, "Fired up, ready to go." Swept up by the moment, Vice President Joe Biden was overheard telling the president , "This is a big f***ing deal."
There were no Republicans at the historic signing. Every Republican in Congress voted against the bill, and Republicans protested anew Tuesday that the measure threatened Americans' freedom.
"We've heard a lot today about how historic this bill is, and it's true. It is an historic betrayal of the clear will of the American people. It is an historic loss of liberty," Republican National Committee Chairman Michael Steele said. "It's not too late to repeal this bill, but to do that we need a change in management at the U.S. Capitol."
Outside Washington, 14 state attorneys general — all but one of them Republicans — filed two lawsuits in federal court challenging the constitutionality of the new law, arguing that its mandate that people must buy health insurance exceeds federal power.
"It forces people to do something — in the sense of buying a health care policy or paying a penalty, a tax or a fine — that simply the Constitution does not allow Congress to do," said Florida Attorney General Bill McCollum, who's seeking the Republican nomination for governor.
He was one of 13 attorneys general who filed one suit, along with those from Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington state.
Virginia Attorney General Ken Cuccinelli, who's also a Republican, filed a separate suit.
The bill, passed Dec. 24 by the Senate and Sunday by the House of Representatives, is designed to provide health insurance by 2019 to 32 million Americans who lack it now, institute new federal regulation of health insurance companies — including a mandate that they insure everyone regardless of prior medical problems — and curb costs.
Despite the fanfare at the White House, the law was just one step of a grand political bargain that was needed to get it through the House and to the president's waiting pen.
Soon after the signing, the Senate took up the second step, a "reconciliation" plan to amend the law in order to change the way it would finance the benefits and strip out some of the deals used to win Senate votes on Christmas Eve, such as the "Cornhusker kickback" of Medicaid benefits just for Nebraska.
The combined plan would cost an estimated $938 billion over 10 years. Financed by tax increases and cuts in Medicare, it would reduce the federal budget deficit by $143 billion over the decade, according to the nonpartisan Congressional Budget Office.
It's the broadest move by the federal government to guarantee health care since the creation of Medicare for the elderly in 1965. It exceeds the expansion of Medicare to cover prescription drugs, passed by the Republicans and signed into law by President George W. Bush in 2003.
The Senate expects a final vote Thursday on the reconciliation plan. The House already has approved it.
Republicans suffered a major blow from the Senate parliamentarian late Monday in their effort to derail the reconciliation bill.
According to GOP Senate officials, Parliamentarian Alan Frumin gave them informal guidance that a key part of their plan to challenge the bill won't hold up.
Republicans' best hope of overturning the reconciliation legislation involved Social Security. Their thinking went like this: Since the new bill delays an excise tax on high-end insurance plans until 2018 — it's due to begin in 2013 in the Senate bill — that would mean less revenue for Social Security, and thus wouldn't be permissible under reconciliation rules.
However, the parliamentarian advised them that the tax delay was in order.
Republicans still plan a series of procedural challenges as well as amendments. Sen. Judd Gregg of New Hampshire, the top Republican on the Senate Budget Committee, set the tone by calling the legislation "the fourth major step forward in the push to drive this country down a road towards a European-style government."
The other three, he said, were "quasi-nationalization of the financial system, nationalization of the automobiles, quasi-nationalization of the health industry and now this bill has in it, which nobody's focused on, the nationalization of the student loan industry."
Democrats stuck to a different script, citing examples of individuals and businesses who'd benefit under the new law. Senate Majority Leader Harry Reid, D-Nev., who's facing a difficult re-election campaign, described how some 24,000 small businesses in his state now will be able to afford insurance for their employees.
WHAT IT DOES The bill is expected to insure about 32 million more Americans by 2019, according to the CBO, or 94 percent of eligible Americans. Currently, about 83 percent are insured.
Obama's signature triggers a series of changes in health care laws almost immediately. By mid-June, high-risk coverage pools would be available for people who lack insurance because of pre-existing conditions.
By fall, insurers would be barred from denying people coverage when they get sick, denying coverage to children with pre-existing conditions and imposing lifetime caps on coverage. After September, people could stay on their parents' policies until they turn 26. After Jan. 1, insurers would have to offer small group and individual plans and would have to spend 80 percent of their premium dollars on medical services. Large group plans would have to spend at least 85 percent.
The bill would require most people to obtain coverage, and most employers to offer it, starting in 2014. It would create exchanges, or marketplaces, in which consumers could shop more easily for policies.
The reconciliation bill makes several changes to the Senate-drafted measure. In 2013, it would increase the Medicare payroll tax and expand it to dividend, interest and other unearned income for singles who earn more than $200,000 annually and joint filers who make more than $250,000. Starting in 2014, it would increase subsidies for families earning up to 400 percent of poverty level, currently about $88,000 a year.
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