House Speaker Nancy Pelosi, California Democrat, clutches a pen used by President Obama to sign the health care bill on Tuesday, March 23, 2010, in the East Room of the White House in Washington. (AP Photo/J. Scott Applewhite)

Photo by: J. Scott Applewhite

House Speaker Nancy Pelosi, California Democrat, clutches a pen used by President Obama to sign the health care bill on Tuesday, March 23, 2010, in the East Room of the White House in Washington. (AP Photo/J. Scott Applewhite)