WASHINGTON — Congress Thursday passed and sent to President Barack Obama the final piece of landmark health care legislation intended to change dramatically how most Americans buy, use and maintain insurance coverage.
The House approved the bill by a vote of 220-207 Thursday night, hours after the Senate passed the measure by a vote of 56-43. No Republicans in either chamber voted for the bill.
This legislation, combined with the bill signed into law on Tuesday, will bring the most significant change in health care policy since Medicare was created in 1965 to provide health insurance coverage for seniors and the disabled.
Republicans vowed to campaign for repeal in the fall election season, drawing a quick challenge from President Barack Obama: "Go for it."
Underscoring the partisan divide that has characterized the long-running health care fight, all voting Republicans in the Senate opposed the measure, as did three Democrats: Arkansas Sens. Blanche Lincoln and Mark Pryor and Nebraska Sen. Ben Nelson. Florida Democrat Bill Nelson voted in favor, while Republican George LeMieux voted against.
Voicing his party's opposition, Senate Republican leader Mitch McConnell of Kentucky said the GOP won't give up "until this bill is repealed and replaced with common-sense ideas."
In a nod to the late Sen. Edward Kennedy, D-Mass., who had spent a career championing health care for all Americans, the Senate observed a moment of silence in his honor before voting.
Senate Majority Leader Harry Reid, D-Nev., asked senators to cast their votes from their desks, a seldom-used procedure the chamber employs only for the most significant measures. Democrats did so in a bow to the initiative's importance to their party, but some Republicans did not.
Roll call record
It took 42 consecutive roll call votes before the Senate finally approved the 153-page package of amendments Thursday, a record for continual voting often called a "vote-a-rama."
That included 41 Republican amendments, with Democrats defeating every one, and then final passage.
Seantors voted until after 2 a.m. Thursday, then resumed the roll calls later in the morning, tallying a total of 13 hours of relentless voting.
"This has been a legislative fight that will be in the record books," Reid said before the final Senate roll call.
Eager to get the contentious battle behind them, Democrats originally hoped the Senate's vote would ship the measure to Obama for his signature. But working with the chamber's parliamentarian, Republicans found two minor provisions in the bill — dealing with future Pell grants for low-income students — that violated congressional budget rules and were deleted from the legislation.
The corrected bill was sent to the House because both chambers must approve identical legislation before it can be sent to the White House.
"This is quite benign," House Speaker Nancy Pelosi, D-Calif., told reporters. "Of all the things they could have sent back this is probably the most benign."
Obama, returning Thursday to the Midwestern city where he first outlined his health care proposal, dared Republicans to attempt a repeal of the measure he signed into law two days ago.
"They're actually going to run on a platform of repeal in November," Obama told a crowd during a campaign-style event at the University of Iowa Field House in Iowa City. "My attitude is, go for it.
"If they want to have that fight, we can have it. Because I don't believe the American people are going to put the insurance industry back in the driver's seat," Obama said.
Inside the arena, a heckler shouted, "What about the public option?"
"That's not in it," Obama responded.
"Why not?" the heckler yelled back.
"Because we couldn't get it through Congress, that's why," Obama said, adding later, "Thirty-two million people are going to have health insurance because of this legislation. That's what this work is about."
The legislation the Senate approved on Thursday would change the new health care law by making drug benefits for Medicare recipients more generous by gradually closing a gap in coverage, increasing tax subsidies to help low-income people afford health care, and boosting federal Medicaid payments to states.
It would kill part of the new statute uniquely giving Nebraska extra Medicaid funds. The package also scales back a new 40 percent excise tax on high-end "Cadillac" health plans and delays its implementation until 2018.
By 57-42, Democrats rejected an amendment by Sen. Tom Coburn, R-Okla., barring federal purchases of Viagra and other erectile dysfunction drugs for sex offenders. Coburn said it would save millions of dollars, while Sen. Max Baucus, D-Mont., called it "a crass political stunt."
Iinformation from the Associated Press, the Los Angeles Times, McClatchy Newspapers and the Washington Post was used in this report.