The US president has signed a landmark healthcare bill into law, as attention shifts to the senate, which is expected to begin debating another round of changes to the legislation.
Barack Obama signed the bill on Tuesday in the White House East Room before a group of Democratic legislators and individual citizens whose cases he had highlighted during the one-year campaign to get the legislation passed.
The $938bn legislation guarantees health coverage for 32 million uninsured Americans and will touch nearly every citizen's life.
"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," Obama said at a ceremony at the White House on Tuesday.
Parliamentary objections
The legislation no longer contains the universal healthcare option Obama initially proposed.
And even this stripped-down version - which passed along partisan lines - is facing political challenges.
The US senate must still pass a reconciliation or "fix-it" bill that would detail how to pay for healthcare overhaul.
Republican politicians are also promising to use a number of parliamentary objections to try and stall its passage in the senate, and are threatening to undo the measure.
The approval fulfils a goal that had eluded many US presidents for a century - most recently Bill Clinton in 1994.
Republican critics said the legislation was a heavy-handed intrusion in the healthcare sector that will drive up costs, increase the budget deficit and reduce patients' choices.
They also say they would fight a package of changes designed to improve the bill, which will be taken up in the senate this week, and lead a charge to repeal the bill after reclaiming congress from the Democrats in November's elections.
"We will challenge this all over America, and the will of the people will be heard," John McCain, a Republican senator and 2008 presidential contender, said.
Republicans said they would challenge the changes to the overhaul on parliamentary points of order that, if upheld, could send the revisions back to the House.
Legal challenge
At least 13 states, including Florida, Michigan and Alabama, plan to come together in a collective lawsuit claiming the reforms infringe on state powers.
Rob Reynolds, Al Jazeera's correspondent in Washington, said: "So far, 13 state attorney-generals ... have announced they are going to challenge the bill on constitutional grounds.
"They say it is a seizure of too much power by the federal government.
"And so that fight will play itself out in federal and state courts and probably go all the way to the supreme court, and so this fight is not over yet."
Obama was at his lowest point in public opinion polls, 15 months into his presidency, and there were questions about whether he would be able to accomplish anything on his domestic agenda if he could not get the healthcare bill passed.
The passage of the bill was also a victory for Democrats, who can now cite it as an accomplishment when they face voters in midterm congressional elections in November.
Long-term problems
Physicians for a National Health Program (PNHP) is a single issue organisation that advocates for a universal, comprehensive single-payer national health program.
Al Jazeera interviewed Matt Hendrickson, a doctor from California and PNHP member, who said the recently signed healthcare law is good for the short-term, but in the long run it could prove disastrous.
"What it's [US healthcare law] doing is transferring half a million dollars to the private insurance industry so it will enrich and entrench the private insurance industry in what is the fundamental flaw of the American healthcare system, that it is a for-profit private insurance base model that can't cover all Americans and can't control costs.
"In the short time, as a physician, it's hard for me not to appreciate any attempt being made to increase coverage. Currently we have about 50 million Americans who have no insurance and 50,000 of those will die every year because of a lack of insurance, so it's hard for me to oppose any attempt to increase Medicaid to give subsidies to people to purchase insurance," he said.
Hendrickson said: "Unfortunately, in the long term, the chances for true reform might be harmed by the fact that the private insurance industry becomes wealthier and stronger.
"At least 23 million people will remain uninsured although that number will probably grow because as we've seen in the Massachusetts model and in several other state models the initial attempt to subsidize those that can't afford the insurance slowly diminishes because the costs are not controlled and the government can no longer keep up with the rising costs."
http://english.aljazeera.net/news/americas/2010/03/201032316847544350.html
