After more than a year of grueling attempts and legislative fits, starts and stand-offs, President Obama signed his $871 billion health care reform bill into law at the White House on Tuesday. In doing so, Obama put his mark on the largest overhaul of the American health care system since the passage of Medicare in 1965.
"Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied, health insurance reform becomes the law of the United States of America," Obama said. "The bill I'm signing will set into motion reforms that generations of Americans have fought for and hungered to see."
Obama noted that the bill will take four years to fully implement, but listed the reforms that will begin within the next six months, including tax credits to 4 million small businesses to cover employees' insurance; an end to recisions by insurance companies of customers who get sick; an end to caps on coverage; and a provision to allow young adults to remain on their parents' policies until they are 26 years old.
Watching Obama sign the bill in the East Room were House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and more than 150 smiling, cheering Democratic members of Congress, clearly relieved to have delivered a major legislative victory to the president on his top domestic policy goal.
The members of Congress repeatedly erupted into applause during Obama's remarks and loudly reprised Obama's 2008 campaign chant of "Ready to go, fired up!" as the event began.
Also at the ceremony were Victoria Kennedy and Caroline Kennedy, the widow and niece of the late Sen. Ted Kennedy, who had championed health reform during his Senate career. Noticeably absent at the event were Republicans, none of whom voted for the bill.
Vice President Joe Biden introduced the president and praised Obama for leading the reform effort. "You're the guy who got it done," Biden said. "You've done what generations of not just ordinary, but great, men and women have attempted to do. . . . You have turned the right of every American to have access to quality health care into a reality for the first time in history."
In addition to the details the president listed, the legislation will also require every American to purchase health insurance and will penalize large businesses that do not provide insurance for their employees. By 2014, individuals will be able to shop for insurance through new health care exchanges, and will be subsidized by the government if they cannot afford it. About 15 million low-income Americans will be added to Medicaid, an element that governors have vocally opposed because of the unfunded mandates associated with it.
To pay for the reforms and expansions, the bill will impose a 40 percent excise tax on expensive insurance policies, add fees on pharmaceuticals and medical devices, and collect penalties from individuals and large business that do not buy the coverage required by the new law.
Some features of the bill would be changed by a package of "fixes" that the Senate will begin debating this week. The package would remove portions of the bill that some House Democrats had vocally opposed, including portions of the excise tax on insurance policies, and the "Cornhusker Kickback" that would have paid for Nebraska's entire Medicaid expansion. The reconciliation bill also includes billions of dollars in additional subsidies for people to buy insurance and a significant overhaul of the federal student loan program. (Read more about that here
President Obama also signed an executive order earlier this week explicitly stating that no funds from the health reform package would be used for abortion services or abortion coverage.
Republicans have vowed to bring legal challenges to the bill and to work to repeal it in Congress. Sen. John McCain blasted the bill on the Senate floor Monday and promised that Democrats will suffer for their efforts during the upcoming midterm elections. "We are going to try to repeal this," McCain said. "We are going to have a very spirited campaign coming up between now and November. And there will be a very heavy price to pay for it."
The president dismissed Republican objections as "game playing that passes for governing in Washington," and said that Republicans' rhetoric will now meet the reality of the bill that has passed.
"Today we are not a nation that scales back its aspirations. We are not a nation that falls prey to doubt or mistrust. We do not fall prey to fear. We are not a nation that does what's easy -- that's not who we are or how we got here," Obama said. "We are a nation that does what is hard, what is necessary, what is right.
"Here in this country, we shape our own destiny. That is who we are and is what we do."
As his fellow Democrats looked on, the president then signed the bill into law, using 20 different pens that he will give to his allies who helped clear the way for what is likely to be the defining domestic issue of his presidency.