Among the new rules on insurance companies are banning lifetime dollar limits on policies, coverage denials for pre-existing conditions, and policy cancellations when someone gets sick. Insurers also will have to allow parents to keep children on their plans up to age 26.
The changes are to be paid for with cuts in projected government payment increases to hospitals, insurance companies and others under Medicare and other health programs, an increase in the Medicare payroll tax for some, fees on insurance companies, drug makers and medical device manufacturers, a new excise tax on high-value insurance plans and a tax on indoor tanning services.
For seniors, the plan will gradually close the "doughnut hole" prescription coverage gap and improve preventive care. But it also will cut funding for popular private insurance plans offered through Medicare Advantage. About one-quarter of seniors have signed up for such plans, which generally offer lower out-of-pocket costs.
Democrats, led by Obama, celebrated a "new wind at our backs" from an achievement accomplished after more than a year of high tension and deep division — stretching back to shouted protests that interrupted lawmakers' town hall meetings on the subject last summer. Obama signed the measure less than two days after the cliffhanger final House vote in a rare Sunday night session.
"Our presence here today is remarkable and improbable," Obama said, his grin wider than any in recent memory. "With all the punditry, all of the lobbying, all 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."
At a second celebration later, he said, "After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise. It is the law of the land."
The president now faces the task of selling to the public a bill that satisfies neither side of the political spectrum.
Liberals bemoan that a government-run plan to compete with private ones was shed from the legislation during bitter negotiations. Conservatives fear an expansion of government and costs they say will bankrupt the country, despite an estimate from the nonpartisan Congressional Budget Office that the law will cut federal budget deficits by an estimated $143 billion over a decade.
Obama's explanatory hurdle is not an easy one, given the law's multilayered provisions and timetables. A bumper-sticker slogan it is not. But he must help protect the Democrats — particularly those from conservative-leaning districts — who stand to suffer in the fall elections from their votes.
Republicans face a challenge as well. Aware of traditional American suspicions of government intrusion, they cast themselves throughout the process as against major changes. They now must explain to voters impatient for action in Washington why nothing was their best choice.
In a hint of the coming Republican line of argument, Sens. Judd Gregg, R-N.H., and Jon Kyl, R-Ariz., said the new law would push the United States to a "European-style" government.
More than a dozen Republican senators, including Utah's Bob Bennett, introduced legislation to repeal the law that Sen. Jim DeMint, R-S.C., said would "force taxpayer funding of abortions, raise health costs, hike taxes, cut Medicare, raid Social Security and put bureaucrats between patients and their doctors."
"Repeal and replace," Senate Minority Leader Mitch McConnell, R-Ky., told reporters.
Obama planned to sign an executive order today affirming existing law against federal funding of abortions, except in cases of rape, incest or danger to the woman's life. A critical bloc of anti-abortion Democrats had pledged to vote against the health care package unless given greater assurances that it would not amend current law. In a last-minute deal, Obama agreed to issue the order to get their votes.
Contributing: Donna Cassata and Brendan Farrington
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