Obama signs health care reform into law

Barack Obama signs landmark US healthcare bill into law.

US President Barack Obama has signed his landmark healthcare bill into law in a ceremony at the White House.

For House Speaker Nancy Pelosi enactment marks the pinnacle of her career, delivering a landmark law that has eluded Democrats for decades without a single Republican vote. Weeks after insisting that the House could not pass the legislation, the San Francisco Democrat led her chamber to do just that, showing a mastery of legislative maneuvering unmatched by any of her predecessors from either party in recent memory.

On Tuesday, Obama singled out Pelosi as "one of the best speakers the House of Representatives has ever had," and Republicans turned to her as the chief target of their ire. So widespread were her kudos that she rivaled the president as the Washington leader most responsible for bringing Democrats' hard-fought victory to fruition.

The East Room ceremony marked the start of a White House campaign to sell the $940 billion, 10-year legislation to a public that is still skeptical and confused after a year of bitter debate that deeply divided the nation and gave rise to the conservative Tea Party movement.

Republicans scoffed at Democratic claims that the political tide would turn.

Sen. Jim DeMint, R-S.C., introduced a bill to repeal health reform, while 13 Republican state attorneys general filed suit to strike the legislation as unconstitutional, arguing that the federal government cannot force individuals to purchase health insurance, as the legislation would require in four years.

Most states require individuals to carry auto insurance, and the White House predicted the lawsuits would be easily defeated.

But Nebraska Attorney General Jon Bruning argued that it is akin to forcing people to buy electric cars. Other states filing suit were Florida, Michigan, Texas, South Carolina, Pennsylvania, Utah, Alabama, South Dakota, Louisiana, Idaho, Washington and Colorado.

"With all due respect, you don't pass a bill the American people didn't want, then try to sell them on it," said Senate Republican leader Mitch McConnell of Kentucky. "Democrats here in Washington can celebrate all they want. But that celebration is going to be short-lived. The American people aren't fooled."

The final legislation is not yet complete, as the Senate opened debate on a separate package of changes that the House approved as a condition of passing the underlying Senate legislation. The Senate parliamentarian turned back the first GOP attempt to defeat the bill on parliamentary grounds.

Democrats are using a special procedure known as reconciliation to pass the bill on a simple-majority vote to avoid a Republican filibuster.

But Republicans have many more amendments in store aimed at changing the bill and embarrassing Democrats. If any succeed, they would require the House to pass the second bill again, opening a can of worms for Pelosi. The White House is counting on Democrats sticking together to defeat those amendments.

The history of most middle-class entitlement programs, such as Social Security, Medicare and the Medicare prescription drug benefit, suggests that once enacted, they gain popularity as people begin receiving benefits and worry less about the cost to taxpayers.

The provision likely to prove most unpopular is the mandate that everyone carry insurance or pay a fine, but that will not go into effect until 2014.

Popular changes, such as a ban on policy cancellations when people get sick, will go into effect within months. Uninsured people with pre-existing conditions will be able to buy into a temporary high-risk pool, and children with such conditions can no longer be denied coverage. Parents will also get to keep adult children on their health plan until they turn 26.

Polls are mixed. A USA Today/Gallup poll showed a nine-point turnaround in support for health care reforms since the House passed the bill on Sunday, with 49 percent now favoring the law versus 40 percent opposed. A Bloomberg poll found support stuck at about 40 percent.

The legislation, while complex and far-reaching, is not as revolutionary as either side portrays it. Most people with employer-paid insurance are likely to see few changes, at least in the short run. The overhaul maintains the structure of employer-provided health care that many experts believe is the root of the current system's dysfunction.

There is an expansion of public programs, especially Medicaid, but government already pays for more than half of U.S. health care delivered in the United States. Private insurance not only survives, but it will be expanded.