President Obama signs landmark health bill into law

By Scott Wilson, Lori Montgomery and William Branigin
Washington Post Staff Writers
Tuesday, March 23, 2010; 3:54 PM 

President Obama signed a landmark health-care bill into law Tuesday, enacting a sweeping overhaul of the nation's $2.5 trillion health system after a year-long effort that he said shows the United States "faces its challenges and accepts its responsibilities."
"The bill I'm signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see," Obama said before putting his signature on the legislation. While he said it would take four years to fully implement some of the law's provisions, he highlighted measures thattake effect this year.
In a ceremony in the East Room of the White House, Obama signed the massive bill after addressing a congratulatory audience that included lawmakers who supported the measure. No Republicans voted for the bill in the House or Senate, and Democrats who opposed it were not invited, White House officials said. They said those Democrats would not have wanted to attend anyway.
Republicans bitterly denounced the legislation Tuesday, and more than a dozen GOP state attorneys general promptly filed lawsuits challenging it as unconstitutional.
"Most Americans out there aren't celebrating today," Senate Minority Leader Mitch McConnell (R-Ky.) said later in a floor speech. "They're dumbfounded by the fact that Congress just passed this 2,685-page monstrosity against their wishes."
Before Obama spoke, Vice President Biden offered effusive praise for the president in an introduction that hailed him as a historic leader for pushing his signature domestic initiative despite long odds.
"Mr. President, you're the guy that made it happen," Biden told Obama to applause from the gathering. As Obama stepped to the lectern, Biden embraced him and was captured on the microphone telling him, "This is a big [expletive] deal."
Obama told the audience, "Today I'm signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days." He also dedicated the bill to a list of other Americans who have contacted him about their health-care problems, some of whom were in attendance.
He said it has been easy at times to succumb to cynicism and to doubt America's ability to overhaul its health-care system.
"But today we are affirming that essential truth . . . that we are not a nation that scales back its aspirations. We are not a nation that falls prey to doubt or mistrust," Obama said. "We are a nation that faces its challenges and accepts its responsibilities."
He concluded: "Here in this country we shape our own destiny. . . . That is what makes us the United States of America. And we have now enshrined . . . the core principle that everybody should have some basic security when it comes to their health care."
Before he signed the overhaul of the health-care system, a Republican attempt to torpedo the final piece of the package failed.
After meeting Monday with representatives of both parties, the Senate parliamentarian, Alan Frumin, determined that the final element of the health package could advance under fast-track budget rules, known as reconciliation, that protect it from a Republican filibuster.
The Senate moved to take up the reconciliation bill Tuesday afternoon.
Together, the two pieces of legislation would cost $940 billion over the next decade and extend health-insurance coverage to an estimated 32 million Americans who are currently uninsured. The package is aimed at stemming the soaring growth in the cost of health-care and reducing the federal deficit by more than $1.3 trillion over the next 20 years.
Referring to the reconciliation bill, Obama said the Senate "still has a last round of improvements to make" to the legislation, and he expressed confidence that the Senate would make them "swiftly." The remark drew cheers from the House members in the audience, who narrowly passed the Senate bill and the House fixes Sunday night in separate votes.
The White House later issued a statement expressing strong support for the reconciliation bill, which it said includes provisions to "eliminate wasteful subsidies for student loan lenders."
Obama said the legislation was a testament to "the historic leadership and uncommon courage" of the lawmakers, "who have taken their lumps during this historic debate." That elicited more cheers, as well as laughter when one legislator interjected, "Yes, we did."
After the signing ceremony, Obama headed to the Interior Department for a longer speech to a larger audience including interest groups and others who could not fit into the East Room event.
"After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise," Obama said. "It is the law of the land."
Addressing opponents who he said are still "fighting change" and "still making a lot of noise about what this reform means," Obama sought to dispel what he described as "misinformation" about the legislation. He told senior citizens, "These reforms will not cut your guaranteed benefits." And he said a health insurance exchange scheduled to be established in 2014 was "originally a Republican idea."
Obama said, "I'm confident that you will like what you see: a common-sense approach that maintains the private insurance system but makes it work for everybody."
While many challenges to the nation remain, "we can take our next steps with new confidence, with a new wind at our backs," he said. "Because we know it's still possible to do big things in America. Because we know it's still possible to rise above the skepticism, to rise above the cynicism, to rise above the fear."
Bringing the audience to its feet, Obama continued: "There will be difficult days ahead. . . . But let us always remember the lesson of this day and the lesson of history: that we as a people do not shrink from a challenge; we overcome it. . . . We don't fear the future; we shape the future. That's what we do. That's who we are."
White House advisers have made clear that Obama is more gratified by the passage of the landmark health-care legislation than by actually winning the presidency.
Now a president who has been criticized for being long on ambition and short on accomplishment has achieved something that eluded predecessors as far back as Theodore Roosevelt, who called for health-care reform a century ago.
But, history aside, what does it mean for Obama and his party this November?
The question annoys White House officials, even as they prepare to showcase the legislation's most immediate effects and its historic significance during events such as a trip to Iowa later this week.
"I assume the president will talk about health care for a long time," White House Press Secretary Robert Gibbs told reporters Monday. "I have no doubt that we'll be on the road extensively in the fall as it relates to health-care reform and as it relates to helping those that supported health care last night and supporting Democrats, even some that didn't."
White House officials have said since Obama took office that, if the president achieved his agenda, political success would naturally follow. But Obama is going to have to help it along, as it turns out, given the splits that have opened up within his own party during the long fight for health-care reform.
With some success, Republicans have called the legislation a "government takeover" of one-sixth of the economy, even though, to the left's chagrin, it does not include a government-run insurance option. Obama's East Room signing ceremony marked a renewed effort to counter the Republican argument.
It included Americans who will benefit from the legislation's most immediate impact, some of them characters who have appeared in his speeches over the past year.
Some of those benefits that kick in this year include a provision barring insurance companies from excluding children with preexisting conditions and another that allows children to remain on their parents' health-insurance policy until the children are 26 years old.
A few of the less popular provisions will be phased in over several years, including the requirement that all Americans buy health insurance. Some states prepared legal challenges to that element of the legislation. Gibbs said he expects those suits to fail in court.
Minutes after Obama signed the bill, attorneys general from at least 13 states sued the federal government, alleging that the new law is unconstitutional.
In Virginia, a Democratic state lawmaker launched a campaign Tuesday to try to stop Attorney General Ken Cuccinelli II from challenging the health-care legislation in a separate lawsuit. Cuccinelli, a conservative Republican, fulfilled his pledge to file suit "as soon as the ink is dry" on Obama's signature. Del. David Englin called the effort "an egregious waste" of Virginians' taxpayer dollars.
In the latest political wrangling, Republicans, led by Sen. Judd Gregg (R-N.H.), had argued that the reconciliation bill being taken up by the Senate should be stripped of fast-track protection -- a move that would essentially kill it -- because provisions related to a new tax on high-cost health insurance policies would impermissibly impact the Social Security trust fund. Reconciliation bills are prohibited from making "recommendations" that impact the trust fund.
For days, Senate Democrats have said they were confident they could beat back the parliamentary challenge, the first of many expected this week as the Senate drives toward final passage by Friday. Although the new tax on high-cost insurance policies might affect the sums collected through the Social Security payroll tax, that effect is indirect, they said, noting that nothing in the measure would explicitly impact Social Security. Democrats also noted that numerous reconciliation bills have successfully included policies with a tangential effect on Social Security, including the 2001 tax cuts sought by then-President George W. Bush.
Late Monday, Frumin sent an e-mail to budget aides from both parties, confirming that the challenge "is not well taken," according to a copy of the missive obtained by The Washington Post.
Senate Budget Committee Chairman Kent Conrad (D-N.D.) was cheered by the news: "We believe the parliamentarian is clearly correct based on the precedents," he said in a statement. Republicans did not immediately respond to requests for comment.
The ruling laid to rest a dispute that had been brewing since last week, when Gregg first announced his intent to raise the challenge while the House was still in the final throes of approving the two-part health package.
The House on Sunday approved the health bill passed by the Senate on Christmas Eve -- a tough vote for many House Democrats who disliked the Senate bill -- then passed a package of revisions to remove the most objectionable provisions. Obama opted to sign the main health-care bill into law before the Senate took up the package of revisions.

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