WASHINGTON: President Barack Obama, claiming a triumph that could define his presidency, signed a massive, nearly $1 trillion health care bill Tuesday that will for the first time cement insurance coverage as the right of every U.S. citizen.
The measure will reshape the way virtually all Americans receive and pay for medical treatment.
The signing followed a year of intense political battles and marked a victory that eluded presidents stretching back almost half a century.
The core of the massive law is the extension of health care coverage to 32 million Americans who now lack it.
The White House hopes the victory will revitalize an Obama presidency that has been been consumed with health care reform for much of his first year in office.
At a White House signing ceremony, Obama declared "a new season in America" as Democratic lawmakers cheered him on, shouting and snapping photos with pocket cameras or cell phones.
Vice President Joe Biden was caught whispering a profanity as he exclaimed to the president what a big deal it was.
Opposition Republicans, who had unanimously opposed the bill, said Tuesday that those Democratic lawmakers would pay dearly in November's congressional elections, where health care has emerged as a key issue.
Opinion polls show the American public remains skeptical.
Obama is planning a number of appearances to promote the plan, starting with a trip to the politically pivotal Midwest state of Iowa on Thursday.
Indeed, the reshaping of one-sixth of the U.S. economy, to be phased in over several years, ranks among the biggest changes ever devised by Washington.
That was a main complaint from Republicans who characterize the measure as a costly, wrongheaded government power grab.
Obama and the Democrats portray it as a lifesaver for countless Americans overwhelmed by spiraling medical costs and insurance company practices denying coverage.
In a hint of the coming Republican line of argument, Republican Sens. Judd Gregg and Jon Kyl, said the new law would push the United States to a "European-style" government.
Obama has pushed health care as his top priority since taking office in January 2009.
Failure would have weakened him and endangered other issues on the president's ambitious domestic agenda, including immigration reform and climate change legislation.
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 health insurance 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.
To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on upper income Americans.
Obama's explanatory hurdle is not an easy one, given the law's multilayered provisions and timetables.
But he must help protect the Democrats - particularly those from conservative-leaning districts - who stand to suffer in the November election 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.
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 with constituents 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 at the White House signing ceremony, 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 at the Interior Department, 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."
More than a dozen Republican senators introduced legislation to repeal the law that Sen. Jim DeMint 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 told reporters.
And attorneys general from 13 states - all but one of them Republicans - acted on their opposition immediately, filing a lawsuit to stop the overhaul just minutes after the bill signing.
Florida Attorney General Bill McCollum led the effort to file the suit that claims Congress doesn't have the constitutional right to force people to get health coverage.
It also says the federal government is violating the Constitution by forcing a mandate on the states without providing resources to pay for it.
Obama made clear that the Republican offensive will not go unanswered.
His larger, second event, held in a vast Interior Department auditorium, had a more combative feel. He accused Republicans of telling "lies."
Starting with his Thursday trip to Iowa, where as a presidential candidate he announced his health care plan in May 2007, Obama intends to emphasize the law's most immediate impacts, including the ability of young adults up to age 26 to remain on their parents' health plans and a ban on insurers denying coverage to sick children.
Even as the celebration proceeded in Washington, Congress labored to complete the overhaul with a companion measure containing changes demanded as a condition of House Democrats' approval.
The Senate was poised to consider that bill, with Democratic leaders hoping for its completion by week's end.
Democrats benefit politically from the reform's timeline, because popular parts of the bill take effect soon, while the law's most far-reaching changes don't kick in until 2014, including a requirement that most Americans carry health insurance, or pay a fine.
To make that a reality, tax credits to help cover the cost of insurance premiums will start flowing to middle-class families and the state-federal Medicaid program for low-income people will be expanded.
Among the new rules on insurance companies are bans on lifetime dollar limits on policies, coverage denials for pre-existing conditions, and policy cancellations when someone gets sick. - AP
Latest business news from AP-Wire