Updated: March 22, 12:07 a.m.
House Democrats passed their landmark health care overhaul on a party-line 219-212 vote late Sunday night, marking a stunning turnaround for an undertaking on the brink of collapse just weeks ago and an achievement that leaders said was akin to the enactment of Social Security and Medicare.
The vote sends the Senate's health care bill to the president for his signature following a weekend of high drama. After days of an all-out whip effort led by Speaker Nancy Pelosi (D-Calif.) and President Barack Obama, the outcome was still in doubt until the White House cut a deal Sunday afternoon with a bloc of anti-abortion-rights Democrats led by Rep. Bart Stupak (Mich.) by drafting an executive order reiterating that no federal funding would pay for elective abortions.
The House also approved a package of reconciliation "fixes" to the Senate version of the bill, which will be considered this week by the Senate. A majority of Senators, all Democrats, have agreed to support the reconciliation measure.
Purely in terms of stagecraft, the day's most dramatic moment came after a midday Democratic Caucus — the final in scores the majority has held over the past year to wrestle with health care. During that meeting, House Democratic Caucus Chairman John Larson (Conn.) and Rep. John Lewis (D-Ga.) placed the issue in the context of the civil rights struggle, and both spoke about Lewis' experience 45 years ago leading civil rights marchers across the Edmund Pettus Bridge outside Selma, Ala., where they were assaulted by state troopers. When the Caucus meeting ended, Pelosi, backed by her leadership team, emerged from the Cannon House Office Building room holding the oversized ceremonial gavel that Rep. John Dingell (D-Mich.) had used to call the vote when the Medicare bill was passed in 1965.
"I will use it this evening when we cast a very successful vote for this important legislation," Pelosi said. "We're doing this one for the American people."
Pelosi, Lewis and other Democratic leaders then linked arms and walked out of Cannon and across the street to the Capitol, through a gauntlet of anti-reform tea party protesters shouting "kill the bill!" and a smattering of pro-reform supporters shouting "We vote yes!"
"I think I will remember the walk across the street with John Lewis for the rest of my life," said Rep. Brad Miller (D-N.C.).
The health care reform bill's passage comes after a year of seemingly intractable party infighting. And it comes two months after the effort appeared all but dead following the upset victory of Sen. Scott Brown (R-Mass.) in the special Senate election to replace Sen. Edward Kennedy (D). As he neared the end of his life last summer, Kennedy, the former chairman of the Health, Education, Labor and Pensions Committee, called health reform the cause of his life.
But Pelosi, Obama and Senate Majority Leader Harry Reid (D-Nev.) quickly regrouped, brushing aside Democrats who urged them to scale back the effort and finding a way to appease House Members who had a profound distaste for the Senate bill, in particular its tax on high-cost health insurance plans and a series of special deals cut individual Senators.
Several of those deals will be deleted if the reconciliation package passes the Senate and the "Cadillac" tax will be dramatically scaled back and delayed until 2018 two presidential elections away. The reconciliation bill also boosts affordability credits for buying insurance plans.
The combined package spends $940 billion to expand health care coverage to 32 million Americans while slicing the deficit by $143 billion in the first 10 years and more than $1 trillion in the second decade.
It also raises or creates a host of new taxes, with the largest tax increase hitting the wealthy, and it slices more than $500 billion from expected Medicare costs over the next decade.
Democrats said the bill would extend the solvency of Medicare's trust fund by nine years; Republicans said the cuts would erode services for seniors, and they charged the bill would ruin the economy and the quality of health care while bankrupting the government.
The true turning point for Democrats in their months-long effort came when Stupak and his cadre of like-minded, anti-abortion-rights Democrats announced a deal at a packed 4 p.m. press conference on Sunday — ensuring at least 216 votes for passage of the bill.
Republicans ripped the deal as a betrayal, and the Catholic bishops remained opposed to the package, but Stupak said that there was simply no way for his tougher abortion insurance ban to get through the Senate.
"We'd all love to have a statute," Stupak said. "We can't get 60 votes in the Senate. The reality is we can't do it."
While the White House and Pelosi were heavily involved in negotiating the abortion compromise, at one point on Saturday, talks with Stupak appeared to have broken down as top Democrats sought to splinter his coalition and peel off the support they needed without him.
"It's the damndest process you've ever seen," Stupak said around 3:30 p.m., acknowledging he was no longer in talks with leaders or the White House. During votes later Saturday, Stupak talked on the floor with Dingell, a home-state colleague, close friend and mentor. Stupak had managed Dingell's unsuccessful campaign to hold onto his Energy and Commerce Committee gavel when Rep. Henry Waxman (D-Calif.) challenged him after the 2008 elections — and was crushed when Dingell lost.
Now, Stupak was leading a group of holdouts that was threatening to sink a reform initiative Dingell, and Dingell's father before him, have made their life's work in the House.
The duo agreed to meet in Dingell's Capitol hideaway, where they spent about an hour, one-on-one, talking about the standoff between leaders and the anti-abortion rights group Stupak was leading, Democratic aides said.
Dingell's message: Don't lose hope, and don't walk away. "John Dingell had a piece of me yesterday," Stupak said at his Sunday press conference.
Stupak also had become a hero of sorts to Republicans who hoped abortion would ultimately sink the Democrats' bill. But he went from hero to villain in an instant.
"Anybody who will trade the protections of law for a vague promise which can at best last a few years, is making obviously a terrible trade, one that can never be pictured as pro-life, one that will never be viewed as pro-life, one that by pro-lifers of the future will be viewed as a Benedict Arnold moment," said Rep. Todd Akin (R-Mo.).
But Stupak said the executive order carried the same effect as law.
"Make no doubt about it, there will be no public funds for abortion," he said.
Stupak also said that his group would continue to work to push his stricter abortion language in the future. "I would like some day to get statutorily what the bishops would want," he said.
But he understood that the compromise wasn't going to sit well with either camp.
"Now both sides will be pissed," the Michigan Democrat said with a wry smile.
Democrats and Republican leaders, meanwhile, were already turning their eyes to the fall elections and assessing the impact of the sweeping legislation.
House Majority Leader John Boehner (Ohio) and other GOP leaders predicted the bill would lead to a new Republican revolution sweeping them back into power, and over the weekend he compared the package to "Armageddon."
"We're now about 24 hours from Armageddon, 24 hours from Members casting a vote on one of the biggest bills they'll ever vote for in their careers," Boehner told GOP Members on Saturday during a Conference meeting. "We are right there."
GOP lawmakers exited the meeting to the cheers of protesters who thanked them and urged them to "fight on."
As the debate on the health care bill neared on Sunday, Republicans still raised numerous objections and procedural motions on the House floor to try to delay action, but acknowledged that under the rules adopted by Democrats there would be little they could do to stop the final vote.
"These rules closed the door on everything," Republican Study Committee Chairman Tom Price (Ga.) said. "They have raised tyranny to a new level."
But as Democratic holdouts began to announce their support for the bill, the GOP resolve began to waver.
By the time the vote was held, most of protesters had left and Republicans, who had drawn much of their political energy from the thousands of activists who flooded the Capitol grounds, accepted they had lost.
Democratic Congressional Campaign Committee Chairman Chris Van Hollen (Md.) predicted that the bill would become more popular once it becomes law.
"First of all, the American people are going to wake up the day after the president signs the final package and realize that all the horror stories that Republicans and Glenn Beck and Rush Limbaugh have talked about are just not true. ... They are going to realize the world did not come to an end, and then they are going to begin to see the benefits of legislation."
Democrats pointed to a host of changes that would take place within six months of enactment, including banning discrimination against children with pre-existing conditions, banning lifetime insurance caps, banning rescissions when people get sick and beginning to close the "doughnut" hole for Medicare prescription drug benefits.
"There is going to be a huge credibility gap on the other side," Van Hollen said.
Van Hollen also said that Democrats are eager to defend the bill on the campaign trail.
"I don't quote George Bush much, but bring it on,'" he said.
Jackie Kucinich contributed to this report.