Capping a bitterly fought battle over the top item on President Obama's domestic agenda, the House gave final approval to the health overhaul Thursday, after the Senate made changes and returned the measure earlier in the day.
The House voted 220-207 for the bill, which now heads to Obama for his signature. No Republicans supported the measure.
Democrats who were eager to put the long fight over health care behind them had hoped a Senate vote would finish the job. But Republicans identified problems with two provisions relating to Pell Grants for low-income students that violated the rules of the budget reconciliation process, which Democrats were using to speed the bill's passage and block a filibuster.
The provisions were stripped from the bill, and the Senate passed it on a 56-43 party-line vote. No Republicans voted for the measure, and three Democrats also opposed it.
Under reconciliation rules, the legislation had to get kicked back to the House because of the changes.
Shortly before the Senate vote, Obama delivered a message to Republicans who said they will try to repeal his health care overhaul: "Go for it." Obama was at a campaign-style rally in Iowa to bolster support for the new law and explain what it means to average Americans.
A Barrage Of Amendments
The Senate vote followed a nine-hour marathon session stretching past 2 a.m. Thursday in which Democrats defeated 29 Republican amendments, any one of which would have sent the legislation back to the House.
Although Obama signed the health care bill into law Tuesday, the package of changes sought by the House still needed to get through the Senate. So Republicans sought to gum up the process by issuing the barrage of amendments.
One by one, Democrats voted down GOP proposals that, for example, would have rolled back cuts to Medicare and barred tax increases for families earning less than $250,000. They also defeated an amendment that would have prohibited federal money for the purchase of Viagra and other erectile-dysfunction drugs for sex offenders. Sen. Tom Coburn (R-OK) introduced the amendment, saying it would save millions of dollars. Sen. Max Baucus (D-MT) called the proposed change "a crass political stunt."
"There's no attempt to improve the bill. There's an attempt to destroy this bill," Senate Majority Leader Harry Reid said.
"The majority leader may not think we're serious about changing the bill, but we'd like to change the bill, and with a little help from our friends on the other side we could improve the bill significantly," answered Senate Minority Leader Mitch McConnell (R-KY).
Democrats noted that nearly every reconciliation bill has been subject to last-minute revisions.
Republicans And 'Armageddon'
Obama's trip to Iowa City, Iowa -- where as a presidential candidate he announced his health care blueprint -- was the first of many appearances around the country to sell the overhaul to voters before the fall congressional elections.
"Three years ago, I came here to this campus to make a promise," Obama told the crowd gathered at the University of Iowa, "that by the end of my first term in office, I would sign legislation to reform our health insurance system."
The president said there had been "plenty of fear-mongering and overheated rhetoric" about the health care overhaul.
"Leaders of the Republican Party, they called the passage of this bill 'Armageddon,' the end of freedom as we know it," Obama said. "So, after I signed the bill, I looked around to see if there were any asteroids falling," he said to laughter and applause.
"But from this day forward, all of the cynics and the naysayers will have to finally confront the reality of what this reform is and what it isn't," the president said.
Threats And Intimidation Tactics
As Congress wrangles with legislative details, discontent over changes to the nation's health care system has spilled over into threats of violence against lawmakers who voted for the overhaul.
The FBI is investigating at least four incidents in which bricks were thrown through the windows of Democratic offices in New York, Arizona and Kansas, including Rep. Louise Slaughter's district headquarters in Niagara Falls, N.Y. And at least 10 members of Congress reported receiving threatening e-mails, phone calls and faxes.
House Speaker Nancy Pelosi said at a news conference Thursday that intimidation tactics "must be rejected," adding that such behavior has "no place in a civil debate in our country."
Some of the worst threats targeted Michigan Rep. Bart Stupak, an anti-abortion Democrat who cast a key vote for the overhaul in exchange for an executive order prohibiting federal funding of abortion. One man called Stupak's office to say he hopes the congressman gets cancer and dies, while a female caller said "millions of people wish you ill" and "those thoughts will materialize into something that's not very good for you."
House Republican leader John Boehner of Ohio said in a statement that while many Americans are angry over the bill's passage, "violence and threats are unacceptable."
"That's not the American way," he said. "We need to take that anger and channel it into positive change."
Later, House Minority Whip Eric Cantor went on the offensive, saying Democratic leaders were "reckless to use these incidents as media vehicles for political gain."
Cantor said his own campaign office had been shot at and that he had received threatening e-mails this week, but didn't elaborate. He said he would not release the e-mails "because I believe such actions will encourage more to be sent."
Material from The Associated Press was used in this report
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