Obama signs healthcare into law

President Barack Obama hailed the enactment of major healthcare reform Tuesday as Senate Republicans vowed to make the reconciliation process as difficult as possible.

A few hours after a jubilant Obama signed the legislation alongside Democratic congressional leaders in the East Room of the White House, the Senate kicked off consideration of a budget reconciliation “fixes” bill to make changes to the newly minted law.

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Senate Republicans vowed not to make it easy for Democrats, and conservatives on and off Capitol Hill renewed their call for the healthcare law’s repeal.

Obama focused on what he and congressional Democrats had achieved, however, not on what may come next.

“Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied, health insurance reform becomes law in the United States of America,” Obama said.

Standing behind Obama as he signed the legislation, using 20 pens, were Speaker Nancy Pelosi (D-Calif.), Senate Majority Leader Harry Reid (D-Nev.) and other key Democratic lawmakers who shepherded the legislation through Congress.

When Obama arrived, the audience of Democrats started the “Fired up, ready to go” chant that was used during Obama’s presidential campaign. Obama thanked Congress for grinding through the process, acknowledging lawmakers for “taking their lumps” during the bruising debate. “Yes, we did!” shouted back Rep. Gary Ackerman (D-N.Y.), prompting laughter.

Meanwhile, Vice President Joe Biden attracted headlines when, after introducing Obama at the signing event, told the president, "This is a big f------ deal." The remark wasn't meant to be public, but it was picked up by nearby microphones and posted on the Internet.

Back on Capitol Hill, however, congressional Republicans were serious about their opposition.

“I think the slogan will be ‘Repeal and replace,’ ” said Senate Minority Leader Mitch McConnell (R-Ky.), embracing a tactic favored by the conservative movement and echoing comments made earlier Tuesday by House Republican Conference Chairman Mike Pence (Ind.). In addition, 12 Senate Republicans joined their House counterparts in introducing legislation to repeal healthcare reform.

And the attorneys general of 13 states filed a lawsuit Tuesday seeking a repeal of the law, joining the efforts by legislatures in Virginia and other states to defy the new law.

A poll released Tuesday shows that a plurality of the public supports the bill Obama signed into law. In the latest USA Today/Gallup poll, 49 percent said the law is a “good thing” and 40 percent answered to the contrary.

Senate Democrats aim to wrap up debate on the reconciliation bill, which the House passed Sunday in conjunction with its adoption of the Senate’s version of healthcare reform, by the end of the week.

Despite lacking the sufficient numbers to block the reconciliation bill, Senate Republicans made clear they intend to prevent swift action, and thus to draw attention to their criticisms of Democratic healthcare reform.

“I think that the American people need to focus on this second bill, as well,” McConnell said. “We’re going to treat it as a serious legislative exercise.”

Under budget reconciliation rules, filibusters are not allowed and debate time is limited to 20 hours, but senators are permitted to offer unlimited amendments unless the parliamentarian deems them dilatory.

Senate Budget Committee ranking member Judd Gregg (R-N.H.), who will manage the reconciliation bill for the GOP, said the party will focus its amendments on issues such as Medicare cuts, the individual mandate to purchase health insurance and “special deals” struck to secure the votes of individual Democratic senators.

“What we intend to do is to offer a series of substantive amendments the purpose of which is to try to correct some of the fundamental flaws,” Gregg said. “I know we can’t fix it, really, because it’s such a terrible bill.”

Based on the Republican strategy throughout the healthcare reform debate, the GOP is likely to offer many amendments to the reconciliation bill — “one after another,” Gregg said — but McConnell declined to offer much of a preview. “The amendment strategy will unfold as we offer amendments on the floor,” he said.

Amendments are not the Democrats’ main concern, however. The Senate Democratic leadership promised their House Democratic counterparts their conference would unite behind the language approved by the lower chamber to avoid blowing up the compromises the reconciliation bill contains. Senate Majority Whip Dick Durbin (D-Ill.) has instructed Democrats to oppose Republican amendments and not to offer any of their own.

The complex parliamentary rules governing budget reconciliation bills, however, make Democrats vulnerable to GOP points of order that, if upheld, would cause provisions to be stripped from the bill. Even minor changes would require the House to vote again. And, however unlikely, major changes could disrupt the Democrats’ plans to finish healthcare and move on to other issues.

House Majority Leader Steny Hoyer (D-Md.) said he is not worried that the reconciliation bill will be damaged during Senate debate. House Democratic leaders also made clear they could pass the reconciliation bill again if a second vote became necessary.

“I don’t think it’s a concern,” Hoyer told reporters Tuesday. “I’m reasonably confident that the Senate is going to defeat any amendments that are offered on the theory that this is a conference report.”

Republicans suffered a blow Monday evening when the parliamentarian ruled against their contention that changes to the excise tax on high-cost health insurance plans violated reconciliation rules.

Senate Democrats expressed confidence that they prepared the reconciliation bill carefully enough, in consultation with the Senate parliamentarian, that it would survive the process — and in particular that any changes would not directly affect the budget, a requirement under the “Byrd rules,” named after Sen. Robert Byrd (D-W.Va.).

“We think this bill is completely clean,” said Senate Budget Committee Chairman Kent Conrad (D-N.D.). “In the last 12 hours, we’ve found additional precedent that supports our view that nothing is ‘Byrd-able.’ ”

Senate Finance Committee Chairman Max Baucus (D-Mont.) conceded that some small provisions might not make it through floor consideration, but downplayed the issue.

“We’ve scrubbed this thing so well,” Baucus said. Any deletions that might occur on the floor would be “so minor they’re almost not even worth mentioning.”

One Senate Republican known well for his penchant for delay tactics acknowledged as much.

“We’ll put a few holes in it, but basically it’s going to come through here because they’ve done a good job crafting it,” Sen. Tom Coburn (R-Okla.) said during a Monday interview on CNBC. Coburn introduced nine amendments to the reconciliation bill Tuesday.


Eric Zimmermann and Michael O’Brien contributed to this article.