Capping an epic struggle, congressional Democrats put the final touches Thursday to historic legislation enshrining healthcare as the right of every citizen. Republicans vowed to campaign for repeal in the fall election season, drawing a quick retort from President Barack Obama: "I welcome that fight."
The president spoke in Iowa as the Senate voted 56-43 for legislation making changes, including better benefits for seniors and low-income and middle-class families, to the bill he signed into law with a flourish at the White House on Tuesday.
The House added its approval a few hours later, 220-207, clearing the way for Obama's signature on the second of two bills that marked the culmination of what the president called "a year of debate and a century of trying" to ensure coverage for nearly all in a nation where millions lack it. Obama is expected to sign the legislation early next week.
Taken together, the two bills also aim to crack down on insurance industry abuses and to reduce federal deficits by an estimated $143 billion over a decade. Most Americans would be required to buy insurance for the first time, and face penalties if they refused.
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 monthslong battle in Congress, the political struggle was morphing into a new phase, where public debate was tinged with violence — and politicians accused one another of seeking to exploit it for their own advantage.
Apart from their impact on nearly every American and an estimated one-sixth of the American economy, the week's events marked Obama's biggest political triumphs since he took office more than a year ago.
A pending arms control agreement with Russia, announced on Wednesday, added to his resume, and White House officials said they hoped the momentum would translate into further political successes in the run-up to the midterm elections.
More than 10 lawmakers in the House said they had received threats or worse as a consequence of the healthcare 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 and faxes. An undisclosed number of lawmakers were under increased police protection.
Speaker Nancy Pelosi, D-Calif., and the GOP leader, Rep. John Boehner of Ohio, both denounced the threats and incidents of violence. But Democrats said Republicans had been too slow to respond, drawing an outraged response in return.
"By ratcheting up the rhetoric, some will only inflame these situations to dangerous levels," said Republican Whip Eric Cantor of Virginia. "Enough is enough. It has to stop."
An aide to Rep. Chris Van Hollen of Maryland, head of the Democratic 2010 campaign effort, responded: "This is straight out of the Republicans' political playbook of deflecting responsibility and distracting attention away from a serious issue."
"Repeal and replace" was the new slogan for Republicans as they pivoted away from earlier attempts to kill the healthcare legislation.
Officials said it was meant to appeal to tea party activists — who staged an occasionally unruly demonstration outside the Capitol over the weekend — as well as to independent voters eager for changes in the healthcare system but fearful the Democrats went too far.
"Republicans fought on behalf of the American people this week and will continue to fight until this bill is repealed and replaced with commonsense ideas that solve our problems without dismantling the healthcare system we have and without burying the American dream under a mountain of debt," said Senate Republican leader Mitch McConnell of Kentucky.
Repeal was far-fetched in the extreme since Republicans are now deep in the minority in both houses and would need a two-thirds majority to overcome a certain veto by Obama.
But Republicans circulated polls showing public backing for the overhaul at no better than 40 percent, despite months of Democratic efforts to rally support. Attacking the bill as a government takeover of healthcare paid for in higher taxes and Medicare cuts, they taunted House Democrats who voted for it, saying those lawmakers had cleared the way for their own defeat this fall.
Democrats said any unease was the result of months of Republican distractions — as far back as last summer's debunked charges of "death panels" — and predicted the public would warm to the new law once its first benefits take effect.
That was Obama's pitch in Iowa, where he trumpeted a "set of reforms" that will take effect before the elections.
He said small businesses would be eligible for tax credits to help them cover the cost of insurance for employees, including a $250 rebate from the government for seniors with high prescription drug costs.
"This year, insurance companies will no longer be able to drop people's coverage when they get sick, or place lifetime limits or restrictive annual limits on the amount of care they can receive," he said.
"This is the reform that some folks in Washington are still hollering about. And now that it's passed, they're already promising to repeal it. ... Well, I say go for it," he said.
Senate passage of the follow-up measure was nearly along party lines. Democratic Sens. Blanche Lincoln and Mark Pryor of Arkansas and Ben Nelson of Nebraska joined 39 Republicans in opposing the legislation. Republican Johnny Isakson of Georgia, who is hospitalized, did not vote.
The House vote followed the same pattern, with 32 Democrats joining 175 Republicans in opposition.
Democrats had hoped the Senate's vote would end their yearlong campaign to overhaul the healthcare system. But Republicans forced the deletion of two minor student loan-related provisions, and that required a revote in the House.
The day's events 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 healthcare 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.
The Senate vote took place with Vice President Joe Biden presiding, a symbolic gesture since his vote was not needed.
Moments before approving the legislation, the Senate paused for a moment of silence in memory of Sen. Edward M. Kennedy of Massachusetts, who died last year after a career of more than 45 years in which he relentlessly pursued legislation to enact national healthcare.
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