President Barack Obama on Tuesday signed into law a drastic overhaul of the US health care system, the culmination of a year-long struggle that deeply divided the country and threatened to derail his vast domestic agenda, dpa reported.
"Today, after almost a century of trying, today after more than a year of debate ... health insurance reform becomes law in the United States of America," Obama declared to often boisterous applause from supporters gathered in the White House East Room.
The seminal moment came after the House of Representatives on Sunday approved a version of the health reforms passed by the Senate late last year. But a second package of changes also approved by the House will have to go through the Senate one last time this week.
The legislation marks the most significant transformation of the costly health care system in more than four decades and aims to provide nearly all Americans with access to at least some form of health insurance.
Obama signed the bill before lawmakers from his left-leaning Democratic Party and individual citizens whose cases he touted on the health campaign trail during the year. Obama used 20 different pens for the signature that will be given to key supporters as keepsakes.
There were no Republicans in the room. The opposition party fiercely opposed the bill as a government takeover and rejected claims that it will reduce costs over the long term. Conservatives vowed to repeal the bill if they regain the majority in Congress.
The president later gave another speech at the Interior Department to mark the occasion before a broader audience of about 600 lawmakers, health care professionals and lobbyists who supported his reform effort throughout the year.
Also attending the ceremonies was Vicky Kennedy, widow of the late senator Edward Kennedy who had made health reform his lifelong cause as a legislator but passed away in the summer before it could be realized. His niece Caroline Kennedy was also present.
The sweeping overhaul is predicted to expand health coverage to about 32 million uninsured Americans and bans certain practices of insurance companies, such as refusing to provide insurance to people with pre-existing health conditions.
The legislation is estimated to cost 940 billion dollars over 10 years, but is reputed to lower the federal budget deficit over the next two decades and tries to cut costs in a health system that engulfs 17 per cent of the US economy.
Health care had been Obama's top domestic priority since he entered office in January 2009, but his popularity suffered greatly as much of the public viewed the reforms sceptically and worried about its effect on their own insurance coverage.
The year-long debate often took a nasty turn, from angry protests at townhall meetings over the summer to demonstrations in Washington over the weekend by conservatives determined to derail the process.
Passage of legislation had been in doubt as late as January, after Republican Scott Brown won a shocking victory in the left-leaning state of Massachusetts that ended the Democratic Party's super- majority in the Senate.
Brown's victory ultimately prompted Democrats to abandon Obama's hopes of returning a bipartisan style of governing to Washington. The health legislation was approved with a rash of procedural tricks that limited the Republican Party's ability to block the bill.
"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."
But "we are not a nation that scales back its aspirations," he said. "We are a nation that does what is hard, what is necessary, what is right."
Republicans hope Obama's gamble will cost his party dearly when much of Congress is up for re-election this November. Most political analysts expect Democrats will drop some seats, but it remained to be seen whether the party would lose its stranglehold on the majority in both chambers.
"I assure you I am not quitting our fight. I believe we must repeal this bill immediately," Senator John McCain, the Republican who challenged Obama for the presidency in 2008, wrote in a message to supporters late Monday.
Conservatives will have one last chance to stall the legislative process, when the Senate this week takes up a raft of changes to the underlying health bill. Obama said he was confident the Senate would "swiftly" approve the so-called "fix-it" bill.
About a dozen Republican states are also gearing up to challenge the health reforms in US courts. They are targeting an individual mandate that for the first time would require all Americans to purchase some form of health insurance.
The White House has said it is confident the court challenges will not be successful.
"My advice from counsel is that ... we'll win these lawsuits," spokesman Robert Gibbs said Monday.