Using Your Vocab

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

"Today we have the opportunity to complete the great unfinished business of our country."

The bill would providehealth coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them.

Republicans have already issued notice that they plan to campaign in this fall's midterm elections on a pledge to repeal it.

(Watch TIME's video "Uninsured Again.")

Republicans flashed handwritten signs with the word No on them, sending the crowd into rapture.

Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

"If we pass this bill, there will be no turning back," warned minority leader John Boehner.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments.

Beginning in 2014, more far-reaching measures will begin to take effect.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters.

That only came after President Obama promised to sign an executive order reaffirming that the bill would maintain a "consistency with longstanding restrictions on the use of federal funds for abortion."

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

"Today we have the opportunity to complete the great unfinished business of our country."

But while the bill is headed toward becoming law, the fighting over it isn't going away anytime soon.

It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

In reality, that executive order was more a symbolic move than an actual concession; the bill's supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

In reality, that executive order was more a symbolic move than an actual concession; the bill's supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

That only came after President Obama promised to sign an executive order reaffirming that the bill would maintain a "consistency with longstanding restrictions on the use of federal funds for abortion."

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

Even so, it will be an anticlimax to Sunday's historic House vote, which will send the underlying Senate bill to President Obama's desk for signature.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

"It's interesting how many faces they recognize," said Republican Congressman Steve King of Iowa.

"This is what change looks like."

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

In reality, that executive order was more a symbolic move than an actual concession; the bill's supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

"If we pass this bill, there will be no turning back," warned minority leader John Boehner.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

(Watch TIME's video "Uninsured Again.")

There was also the distraction of March Madness to pass the hours.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

In reality, that executive order was more a symbolic move than an actual concession; the bill's supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

"Today we have the opportunity to complete the great unfinished business of our country."

It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

Whether it actually achieves that latter ambition, however, is far more uncertain.

Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage - either at work, or by purchasing it on their own - or pay a penalty.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

"It will be the last straw for the American people."

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

She also flashed two fingers in a mischievous V for victory.

Democrats also got into the act.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them.

Government subsidies would be available to those earning up to 400% of poverty.

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

Even so, it will be an anticlimax to Sunday's historic House vote, which will send the underlying Senate bill to President Obama's desk for signature.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

Republicans flashed handwritten signs with the word No on them, sending the crowd into rapture.

And dependent children under the age of 26 would be allowed to remain on their parents' policies if they cannot get health insurance elsewhere.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

Beginning in 2014, more far-reaching measures will begin to take effect.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

"Someone flipped a third finger," she said.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

Democrats also got into the act.

States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers.

But while the bill is headed toward becoming law, the fighting over it isn't going away anytime soon.

But while the bill is headed toward becoming law, the fighting over it isn't going away anytime soon.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

Suspense about the outcome continued until the final hours of the debate.

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

"This is what change looks like."

Obama's Health Care Reform Bill Passed


Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle.

With Democrats chanting the signature line of the Obama presidential campaign - "Yes we can!" - the House voted 219-212 to send a sweeping overhaul of the nation's health care system to be signed into law.

Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage - either at work, or by purchasing it on their own - or pay a penalty.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage - either at work, or by purchasing it on their own - or pay a penalty.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

"Today we have the opportunity to complete the great unfinished business of our country."

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

In reality, that executive order was more a symbolic move than an actual concession; the bill's supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

But while the bill is headed toward becoming law, the fighting over it isn't going away anytime soon.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

There was also the distraction of March Madness to pass the hours.

Democrats also got into the act.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

At one point during the afternoon, the Commander in Chief ordered his health care czar, Nancy-Ann DeParle, to take a break and go out for a run.

And dependent children under the age of 26 would be allowed to remain on their parents' policies if they cannot get health insurance elsewhere.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

"This is what change looks like."

"If we pass this bill, there will be no turning back," warned minority leader John Boehner.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

The bill would providehealth coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

At one point during the afternoon, the Commander in Chief ordered his health care czar, Nancy-Ann DeParle, to take a break and go out for a run.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

"We tonight will make history for our country and progress for the American people," Speaker Nancy Pelosi declared shortly before the vote.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

Suspense about the outcome continued until the final hours of the debate.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down.

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers.

Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama's bill comes as close to that target as anyone has.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

We're glad you're here."

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them.

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation.

(See 10 health care reform ads.)

The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor.

Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.

Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments.

One aide said of Obama: "He's in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket."

It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival - especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions.

"This legislation will not fix everything that ails ourhealth care system, but it moves us decisively in the right direction," Obama said shortly after the historic vote.

Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, "God bless America.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, "Kill the bill."

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure.

States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers.

"Someone flipped a third finger," she said.

Suspense about the outcome continued until the final hours of the debate.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid.