Before an elated White House gathering, President Obama on Tuesday signed into law a historic overhaul of the nation's health care system, celebrating with fellow Democrats a political victory designed to give nearly every American health insurance and embarking on the sales job for a plan still disliked by many voters.
Flanked by the longest-serving member of the House and a fifth-grader whose mother died without health insurance, Mr. Obama said he was delivering on a promise that Democrats have made for decades and that he made a centerpiece of his presidential campaign. He then capped months of often bitter, hand-to-hand legislative trench warfare with the stroke of a pen.
"Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied, health insurance becomes law in the United States of America," Mr. Obama said to raucous applause.
The high spirits prompted some unscripted remarks. Press microphones picked up Vice President Joseph R. Biden Jr. employing an unprintable adjective when describing the scope of the achievement in an aside to the president.
Even as Mr. Obama and his party celebrated, another skirmish in the health care battle formally began as the Senate took up a package of amendments to the just-signed bill. Republicans hope to slow down or block the supplemental measure from passing.
Still, it was an ebullient morning as Democrats gathered in the East Room of the White House to congratulate one another for doing what their predecessors dating back to the Truman administration had failed to pull off. Many of the ecstatic lawmakers came armed with their own cameras to capture the historic ceremony, which was marked repeatedly by standing ovations and cheers.
The new law is designed to extend health care coverage to more than 30 million uninsured Americans at a cost of nearly $1 trillion when it's fully phased in later this decade, an expansion to be funded through a mixture of higher taxes and fees and cuts to existing programs. The bill also curbs what backers say are abuses and shortfalls in the private health insurance market.
Opinion polls have consistently shown a plurality if not majority opposed to the measure, but a USA Today/Gallup survey released Tuesday told a different story, finding that 49 percent of Americans now approve of the overhaul plan compared with 40 percent who disapprove. Democrats are counting on the political tide to turn as Americans discover the law's benefits, though many are not slated to take effect until 2014.
Mr. Obama began the drive to rehabilitate the law's image on Tuesday, pointing to some of its immediate benefits. Those include tax credits to encourage small businesses to offer their employees health insurance and new rules that prevent insurance companies from denying coverage for exceeding lifetime caps on health bills. The law also allows parents to keep dependent children on their health insurance plans through age 26.
Even with the Senate action this week, the Democrats have completed the heaviest lifting and basked in their achievement.
"History is made when a leader steps up, stays true to his values and charts a fundamentally different course for the country. History is made when a leader's passion is matched with principle to set a new course," Mr. Biden said. "Mr. President, you are that leader."
The ceremony took place with no Republican in sight. Every GOP House member opposed the bill, as did 34 House Democrats. A few miles away on Capitol Hill, Republicans said the pain of the yearlong debate - and polls showing falling support for the overhaul plan as the fight ground on - will haunt Democrats for years to come.
"This is a somber day for the American people," said House Minority Leader John A. Boehner, Ohio Republican. "By signing this bill, President Obama is abandoning our founding principle that government governs best when it governs closest to the people. Americans have never felt more disconnected from their government than they do today."
Top Republicans are weighing a push to repeal the law and vowing to take the issue to voters in congressional elections in November. More than a dozen states say they plan to file a constitutional challenge to the bill, focusing primarily on its mandate that all citizens purchase health insurance.
The Obama administration said late Tuesday that it will "vigorously defend" the health care act against any lawsuits.
"We are confident that this statute is constitutional, and we will prevail when we defend it in court," Justice Department spokesman Charles Miller said in a statement.
Among congressional leaders and rank-and-file Democrats in the East Room audience were Vicki Kennedy, the widow of Sen. Edward M. Kennedy; Kennedy's niece Caroline Kennedy; and his son, retiring Rep. Patrick J. Kennedy of Rhode Island.
The entrance of Rep. John D. Dingell, the longest-serving member of the House ever, drew a standing ovation. The Michigan Democrat has introduced a universal health care bill annually since his election to the House in the 1950s.
House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid also received standing ovation. Mr. Obama called Mrs. Pelosi one of the greatest speakers in history.
Mr. Obama also invited several guests to the ceremony, including the sister of Natoma Canfield, an Ohio woman sick with leukemia whose story he cited in the final public lobbying drive for the bill, and 11-year-old Marcelas Owens, whose mother died of pulmonary hypertension while lacking health insurance coverage.
The ceremony was a veritable victory lap for lawmakers who have endured months of political heat and fierce protests. Many feared the surprise election of Massachusetts Republican Scott Brown to the Senate in January - breaking the Democrats' filibuster-proof majority - sounded the death knell for a major overhaul bill.
Democrats were deeply divided as the House and Senate deliberated, split on such issues as taxes, a "public" insurance option and the treatment of abortion in the bill. But the House vote Sunday night appeared to heal many intraparty wounds.
Moderate Democrats such as Sen. Blanche Lincoln of Arkansas reveled in the moment, along with liberals such as Sen. Al Franken of Minnesota. At one point, Mr. Franken shook hands with Rep. Bart Stupak, the pro-life Michigan Democrat who nearly torpedoed passage of the bill before endorsing it hours before the vote.
The bill's passage, Mr. Obama said, is "a testament to the historic leadership and uncommon courage of the men and women of the United States Congress, who have taken their lumps during this difficult debate."
That line prompted Rep. Gary L. Ackerman of New York to shout: "Yes, we did."
On Thursday, Mr. Obama is hitting the road for Iowa City, Iowa, where he will emphasize aspects of the reform that take effect this year.