Congress passed the final repairs to President Obama's landmark health care overhaul plan Thursday, successfully pulling off a plan to circumvent a Republican filibuster put together shortly after Senate Democrats lost their supermajority in January.
The bill passed the Senate 56-43 with five more votes than needed, but it had to go back to the House for another vote after Republicans were able to delete two provisions.
The final changes quickly passed in the House 220-207 sending the legislation to the White House.
The votes cap more than a year of work on Democrats' effort to overhaul the nation's $2.5 trillion health system. On Tuesday, Mr. Obama signed the underlying bill into law.
The heavy lifting behind him, the president spent Thursday in Iowa, trying to persuade a skeptical public to support the plan.
"What this is is a historic step to enshrine the principle that everybody gets health care coverage in this country, every single person," he said near a University of Iowa hospital where, three years ago, he promised to sign health reform into law during his first term.
Republicans already have embarked on a "repeal and replace" campaign, convinced that voter discontent with the plan will win them majorities in the fall mid-term elections. But they condemned a rash of reported violence and threats against lawmakers stemming from Sunday's vote and asked Americans to channel their anger into constructive opposition.
The repair bill includes a provision that effectively fills the Medicare "doughnut hole" of missing drug coverage, reduces the impact of a tax on high-cost insurance plans, imposes a new Medicare tax on wealthy Americans and essentially removes private banks from student-loan industry. House members only agreed to support the underlying reform bill in exchange for the package of repairs.
Senate Democrats praised the "reconciliation" bill's passage as an important series of repairs to a landmark bill.
"Today we made that law even better," said Senate Majority Leader Harry Reid of Nevada.
Democrats passed the bill through reconciliation, a procedural tool that circumvented a Republican filibuster and only needed 51 votes. The move was required when Senate Democrats lost their 60-seat supermajority after Republican Scott Brown won the Massachusetts seat of the late Edward M. Kennedy.
Republicans had threatened to make the process as difficult as possible, promising to stall the Senate with hundreds of amendments and challenges to the reconciliation rules, but ultimately they couldn't do too much.
They were able to eliminate two small parts of the bill -- one a technicality, the other a cap on student Pell grants -- which forces the House to vote again on approving the changes. But all 42 of their amendments failed, largely along party lines.
Senate Republican Whip Jon Kyl of Arizona said the changes weren't major, but made the party's point that reconciliation shouldn't have been used to pass the repairs. Republicans said Democrats were abusing the rules of the Senate to push the final pieces of the health bill through.
"That made it very hard for them to include all of the fixes that their people wanted in there," he said. "They had to leave a lot of that stuff on the cutting-room floor. Even after they scrubbed it very carefully and wrote the bill, a couple items fell out. I think it makes the point that we made, which was reconciliation was not the process to get all of those changes made."
Republicans argued that the partisan health debate threatened to permanently divide the parties in the Senate.
"This bill in process is a game changer in the way the minority will operate, said Lindsey Graham, South Carolina Republican.
He all but ruled out further compromises on the immigration debate, but said he will still work on bipartisan climate-change legislation.
Democratic Sens. Ben Nelson of Nebraska, and Blanche Lincoln and Mark Pryor of Arkansas joined all Republicans in opposition. Ms. Lincoln, who is in a tough re-election fight, had said she planned to vote against the package because it was passed through reconciliation. Mr. Pryor said the repair bill ended up hurting Arkansas by reducing how much the federal government paid for Medicaid.