With the strokes of 22 pens, a buoyant President Barack Obama on Tuesday signed into law the most far-reaching health care overhaul in two generations, vindicating a yearlong struggle in which he staked his presidency on a promise to overcome ferocious opposition and begin to transform the nation's health care system.
In a crowded White House ceremony that was both partisan celebration and recognition of history in the making, House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., raised their arms like victors at a pep rally.
Obama said the moment was proof that a polarized political system that is often the target of national ridicule could still produce substantial change to help everyday people.
"Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied — health insurance reform becomes law in the United States of America," the president said. "Today. It is fitting that Congress passed this historic legislation this week. For as we mark the turning of spring, we also mark a new season in America."
On Capitol Hill, Republicans continued to oppose the legislation. Not a single Republican had voted to make the bill the law of the land. Underscoring the partisan divide, not one Republican lawmaker was present in the East Room; the White House extended invitations only to those who voted for the bill.
The House approved it on Sunday after the Senate approved it on Christmas Eve. A companion "fix-it" bill that the House also approved on Sunday is now being considered by the Senate, giving Republicans one last chance to alter the measure before it begins to transform insurance coverage for millions of Americans.
GOP senators are aiming to gut the "fixes" package, a 150-page addendum to the new law. Because the fixes bill was written under special budget reconciliation rules, it cannot be filibustered. But Republicans vowed to take full advantage of their right to offer unlimited amendments, intending to sabotage the package and create turmoil among Democrats who are counting on its passage.
Under reconciliation rules, the Senate will debate the fixes bill for 20 hours, then hold rapid-fire votes on amendments. That phase could begin as soon as tonight and is likely to end sometime Friday, aides from both parties said, though Reid has suggested a finish on Thursday night.
If the measure is changed, it must return to the House for another vote.
In the East Room signing, Obama was surrounded by congressional Democrats and guests who played parts in the law's adoption.
Obama said, "With all the punditry, all of the lobbying, all of the game-playing that passes for governing in Washington, it's been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve. It's easy to succumb to the sense of cynicism about what's possible in this country.
"But today, we are affirming that essential truth — a truth every generation is called to rediscover for itself — that we are not a nation that scales back its aspirations."
After his remarks he sat down at a small table and signed the $940 billion bill, using two pens for each of the 11 letters in his name. Twenty of the pens would go out as souvenirs, with two reserved for his presidential archives.
With the multiple strokes, Obama achieved something that had eluded presidents since Theodore Roosevelt in the first decade of the 20th century — winning congressional approval of a wide-ranging overhaul of health care.
And he made good on a pledge that originated in Iowa City, Iowa, in May 2007, when as a presidential candidate he first rolled out a plan to cover millions of uninsured Americans.
While Democrats exulted, Republicans, who describe the measure as an example of big government run amok, said it was no day to celebrate.
"This is a somber day for the American people," said Rep. John Boehner, the House Republican leader. "By signing this bill, President Obama is abandoning our founding principle that government governs best when it governs closest to the people."
More than a dozen Republican senators introduced legislation to repeal the law.
The signing ceremony was packed with Democratic lawmakers who have spent the past year writing, shaping and arguing about a health care bill that consumed Washington.
Before the signing, those in the East Room excitedly took pictures of each other with digital cameras and Blackberries. When Obama and Vice President Joe Biden entered, the crowd leapt up and started clapping. Someone started the chant from Obama's campaign: "Fired up, ready to go!"
Yet months of partisan fighting and tedious debates about legislative process have taken a toll. Obama's job approval rating dropped 20 points as the health care debate played out. Congress' approval rating is in the teens.
But even some Republicans conceded that Obama's stepped-up efforts to sell the bill have paid off. These Republicans are tempering a repeal message by saying they would retain some of the more popular elements that Obama is showcasing, rather than return to the status quo.
"With him over the next few weeks being Mr. Salesman and telling people how great the bill is, a repeal argument is insufficient," said Sen. John Thune, R-S.D. "You have to tell people how you will fix it."
The signing ceremony was the beginning of what will be an intense sales pitch by the White House and Democrats to convince Americans of the benefits of the health bill. As soon as it was over, Obama went into campaign mode, traveling to the Interior Department to address a crowd of more than 500 cheering doctors, nurses, patients and federal employees.
Information from the Washington Post and New York Times was used in this report.