Landmark legislation to reform the U.S. health care system passed the House of Representatives in a 219-212 vote late Sunday, culminating a decades-long battle that presidents of both parties had lost and resulting in a historic achievement for President Obama.
The House adopted a bill that the Senate passed in December and followed up with approval of a series of changes to that Senate bill.
But the end of the long health care battle in the House came with a sense that another was just beginning: a struggle between those who believe that the federal government can improve Americans' lives and a movement by people who want Washington out of their lives and out of their wallets.
That divide played itself out in the House chamber, where police whisked away a visitor who interrupted debate with the cry "Kill the bill" and where every Republican lawmaker voted against the health package. It also played itself out on the Capitol grounds, where a huge crowd of "tea party" protesters traded shouts and jeers with a far smaller group of health reform advocates.
Despite the divisions, there was no arguing that the legislation -- a $940 billion combination of measures that will force most Americans to get insurance and help many pay for it -- would be among the most important Congress had passed in decades.
"This is not a victory for any one party," Obama said at the White House shortly after the House voted. "It's a victory for the American people. And it's a victory for common sense. . . . This isn't radical reform, but it is major reform."
Yet Rep. Eric Cantor of Virginia, the House Republican whip, echoed countless other GOP lawmakers who eviscerated the bill as an expensive boondoggle that will harness generations of Americans with debt.
"We have heard loud and clear that the government must stop spending money it doesn't have," Cantor said. "And this $1 trillion bill will do the opposite."
American politicians have been arguing about health care for decades, and Rep. Louise M. Slaughter, D-Fairport, proved it by reading her colleagues a message that President Franklin D. Roosevelt sent Congress in 1939 urging lawmakers to reform health care.
Presidents Harry S. Truman, a Democrat, and Richard M. Nixon, a Republican, had also tried and failed to reform health care, Slaughter noted, as did Democrat Bill Clinton.
But only Obama, working with big Democratic majorities in the House and Senate, was able to pull it off, prompting cheers of "Yes We Can!" -- an Obama campaign slogan from 2008 -- on the House floor as the legislation passed.
Not that passage was easy.
The health care effort seemed doomed when Democrats lost their filibusterproof Senate with the election of Sen. Scott Brown, R-Mass., in January.
Soon, though, the White House and Democratic congressional leaders agreed on a strategy: The House would adopt the health reform bill the Senate passed on Christmas Eve and, on the same day, a bill to amend it to curb its excesses.
And that's exactly what the House did.
After passing the Senate bill, the House quickly rejected a Republican measure to undo the legislation by a vote of 232-199.
Lawmakers then adopted the changes to the Senate bill by a 220-211 vote. The Senate measure will become law as soon as Obama signs it, but the Senate still has to act on the package of fixes.
Momentum for the reform package built throughout last week, but Democrats weren't guaranteed of solidifying the 216 House votes they needed until Obama struck a deal with anti-abortion Democrats on Sunday.
"We wanted to see health care reform, but there was a principle we wanted to see: the sanctity of life," said Rep. Bart Stupak of Michigan, the leader of the anti-abortion Democrats. "Today, the president has announced that he will sign an executive order to reinforce that principle."
The executive order would make clear that the Obama administration will continue to enforce the longtime policy against federal funding of abortion.
"The president has said from the start that this health insurance reform should not be the forum to upset long-standing precedent," said Dan Pfeiffer, White House communications director. "The health care legislation and this executive order are consistent with this principle."
The agreement came as Slaughter, whose district includes part of Buffalo, began debate with an anecdote about a constituent from there.
She said that a man wrote to her about his son, who was suffering from epilepsy, and that as a result of the illness, can't get insurance. That means the family has to drive back-and-forth to New York City, where there is a specialist who will see the man's son even though he is uninsured.
As a result, the man told Slaughter, "we are slowly going broke."
Such things would not happen under the reform legislation, which would bar insurers from discriminating against those with pre-existing conditions.
"We are finally gaining ground against insurance special interests," Slaughter said. "I'm proud to stand up and tell people that this bill is the right thing to do and why the time to act is now."
But Rep. Chris Lee, R-Clarence, said on the House floor that he had heard from thousands of Western New Yorkers who opposed the bill.
One wrote out of fear that the bill would increase the debt burden on the family's children. And another, an Air Force veteran, told Lee: "If anyone thinks government health care is a picnic, I'd like them to try it."
The debate took place with the Capitol surrounded by protesters.
Early in the afternoon, House Speaker Nancy Pelosi, D-Calif., led the Democratic caucus through the crowd as it walked to the House chamber to begin the debate. She walked arm in arm with Rep. John Lewis, D-Ga., a civil rights-era icon who encountered racial epithets by protesters while making the same walk a day earlier.
This time, only one loud, unified chant -- "Kill the bill!" -- arose from the countless tea party protesters to the lawmakers' left. A smaller group to the lawmakers' right chanted: "Health care now!"
Tea party organizers denounced the epithets that were heard a day earlier.
"I absolutely think it's isolated," Amy Kremer, coordinator of the Tea Party Express, told Fox News. "It's disgraceful and the people in this movement won't tolerate it because that's not what we're about."
Despite what happened a day before, several Republicans walked onto a Capitol balcony carrying "Kill the bill" signs, prompting cheers from protesters.
While one man in the crowd carried a sign comparing Obama to Hitler and another sign showed Obama in a coffin, several of the protesters said they were motivated by one thing only: their concern that the health legislation would bankrupt the country.
"A trillion dollars of our money will be going to this," James Hull, an engineer from Norfolk, Va., said, adding that the burden would be paid by his children. "That's what got me involved."
Rep. Brian Higgins, D-Buffalo, said the protesters' concerns were misdirected.
"They should be indignant about the current system," in which health care is far more expensive than in any other nation without offering better results, he said.
Higgins and Lee spoke briefly and uneventfully with the protesters, and Lee said he was glad they were there.
"I'm glad everyone got to look these people in the eye," Lee said. "And they're going to have to do it again in November," when House members will be up for re-election.
Polling data has shown the American people to be deeply divided on the health reform bill, although they tend to favor individual elements of it.
House Minority Leader John A. Boehner, R-Ohio, who has vowed to make health care a central issue in this fall's campaign, said Democrats have ignored their constituents.
"We have failed to listen to America," Boehner said.
Democrats scoffed at such notions, saying they had listened to countless stories of Americans who had lost insurance or been denied coverage. In response, they said, they enacted legislation that, in terms of historic impact, will rival the creation of Social Security and Medicare.
House Speaker Nancy Pelosi, D-Calif., noted that the late Sen. Edward M. Kennedy, D-Mass., had called health care for all Americans "the great unfinished business of our time," but then she added: "That is, until tonight."
News wire services contributed to this report.