With the strokes of 22 pens, a buoyant President Obama on Tuesday signed into law the most far-reaching healthcare overhaul in two generations, vindicating a yearlong struggle on which he had staked his presidency.
In a crowded White House ceremony that was both partisan celebration and recognition of history in the making, House Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Harry Reid (D-Nevada) raised their arms like victors at a pep rally; Victoria Kennedy, widow of health reform champion Sen. Edward M. Kennedy, blew a kiss; and Vice President Joe Biden -- as he embraced Obama -- was caught by an open microphone using an obscenity, exclaiming "This is a big . . . deal."
Obama said the moment was proof that a polarized political system could still produce substantial change to help everyday people.
"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," the president said. "It is fitting that Congress passed this historic legislation this week. For as we mark the turning of spring, we also mark a new season in America."
He spoke from a lectern in the East Room, surrounded by congressional Democrats and guests who played parts in the law's adoption.
Victoria Kennedy and Obama wore blue plastic wristbands that said, "TedStrong." The bands had been distributed last summer as a sign of support for the senator during his battle with cancer.
And Obama gave a wide-swinging handshake to Rep. Dennis J. Kucinich (D-Ohio), a target of presidential arm-twisting who switched his vote from no to yes in the final days.
An administration official later described Biden's gaffe -- whispered into Obama's ear as the two embraced -- as "rational exuberance."
Standing in front of the red carpet leading into the East Room, Obama said: "With all the punditry, all of the lobbying, all of 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; to wonder if there are limits to what we, as a people, can still achieve. It's easy to succumb to the sense of cynicism about what's possible in this country.
"But today, we are affirming that essential truth -- a truth every generation is called to rediscover for itself -- that we are not a nation that scales back its aspirations."
Still to be dealt with is a package of proposed changes in the law designed to deal with features that many House Democrats objected to. The changes are contained in a so-called budget reconciliation bill that was approved by the House and now goes to the Senate, where Democrats hope for speedy approval under rules that bar filibusters.
After his remarks, Obama sat at a small table and signed the bill, using two pens for each of the 11 letters in his name. Twenty of the pens would go out as souvenirs; two were reserved for his presidential archives.
With the multiple pens strokes, Obama achieved something that had eluded presidents since Theodore Roosevelt in the first decade of the 20th century -- winning congressional approval of a wide-ranging overhaul of healthcare.
And he made good on a pledge that originated in Iowa City in May 2007, when -- as a first-term senator from Illinois and underdog presidential candidate -- Obama first rolled out a plan to cover millions of uninsured Americans.
The signing ceremony was packed with Democratic lawmakers who spent the last year writing, shaping and arguing about a healthcare bill that consumed Washington and forced other legislative priorities to the back of the line.
Not a single Republican voted to make the Senate blueprint the law of the land. Underscoring the partisan divide, not one GOP lawmaker was present in the East Room; only those who voted for the bill were invited.
When Obama and Biden entered the room, the crowd leaped out of their chairs and clapped. Someone started the chant from Obama's campaign: "Fired up, ready to go!"
Obama welcomed the waves of applause and whistles and encouraging standing ovations for everyone he thanked.
The new law is a "testament to the historic leadership and uncommon courage of the men and women of the United States Congress, who've taken their lumps during this difficult debate," Obama said.
"Yes, we did!" shouted Rep. Gary L. Ackerman (D-N.Y.).
"But we're still standing!" shouted someone else.
Barely, though. Months of partisan fighting and tedious debates about process have taken a toll. Obama's job approval rating dropped 20 points as the debate played out. Congress' approval rating is in the teens.
New polling shows the public may be warming to the plan. A Gallup poll released Tuesday showed that 49% believed that passage of the bill was "a good thing," compared with 40% who labeled it "a bad thing."
While many Republicans are calling for repeal of the legislation, some are tempering that message by saying they would retain some of the more popular elements that Obama is showcasing, rather than return to the status quo.
"With him over the next few weeks being Mr. Salesman and telling people how great the bill is, a repeal argument is insufficient," said Sen. John Thune (R-S.D.). "You have to tell people how you will fix it."
Beyond threats of repeal, the law faces other challenges. Shortly after the signing ceremony, more than a dozen Republican state attorneys general opened a challenge to the law's constitutionality. They contend that the requirement that everyone purchase health insurance violates the Constitution's commerce clause.
The White House predicted that the new law would hold up, but is girding for a legal fight.
Democrats also worry that the public may exact revenge in the midterm elections. So Obama is leading a continuing push to sell the plan. In his address, he emphasized that people will see improvements in their healthcare coverage soon.
"It will take four years to implement fully many of these reforms, because we need to implement them responsibly," he said. "We need to get this right. But a host of desperately needed reforms will take effect right away."
The new healthcare system will unfold in stages. Within 90 days, a national high-risk insurance pool will be created to provide interim coverage for uninsured adults with preexisting conditions.
In six months, insurers will be banned from placing lifetime limits on coverage and from rescinding policies, except in the case of fraud. Dependent children as old as 26 will have the option of remaining on their parents' plan. And insurers will be required to cover children with preexisting conditions.
Starting in 2014, state-based insurance exchanges will provide a regulated marketplace for consumers to compare policies that must meet federal standards. Also at that point, a requirement kicks in for individuals to carry insurance.
Janet Hook and Kim Geiger contributed to this report.