The US health reform Bill was signed into law by President Obama yesterday in a momentous and momentarily profane White House ceremony that few imagined possible two months ago.
The law brings immediate changes to the rules governing American health insurers and injects new urgency into Republican efforts to repeal the Bill or defeat it in the courts.
Using a rack of 22 pens that will each become cherished souvenirs, Mr Obama signed a measure that ends Americas longstanding distinction as the only advanced economy to lack basic healthcare coverage for all.
He welcomed a new season in America after a century of trying and a year of debate and said that he looked forward to a political season when the heated rhetoric of that debate would confront the reality of reform.
Related LinksJoe Biden: healthcare "is a big f***ing deal"Obama and healthcare: the downsideThis debate is far from overMoments earlier, after Joe Biden, the Vice President, had introduced Mr Obama in the East Room of the White House, Mr Biden leaned in to give his boss a hug and was caught by microphone saying in the Presidents ear: This is a big f***ing deal.
Yesterday a Republican contender for the presidency accused Mr Obama of betraying the nation. Mr Obama had succumbed to the lowest denominator of incumbent power, justifying the means by extolling the ends, said Mitt Romney, the former Massachusetts Governor. The Bill would raise taxes and create new entitlements that the US can ill afford, he added.
The new laws immediate effects include a ban on withholding health insurance from children on the basis of pre-existing medical conditions, and a provision for young adults to stay on their parents policies until the age of 26. A raucous invited audience in the East Room of the White House applauded each ingredient of the Bill as Mr Obama listed them, and gave standing ovations as he paid tribute to Senator Kennedy and to his own mother, who he said argued with insurance companies even as she battled cancer.
On Capitol Hill, conservative senators are attempting to derail a package of amendments to the Bill signed yesterday, using points of order and amendments of their own. In 13 states Republican attorneys-general have announced lawsuits challenging the constitutionality of the reform Bill, while Mr Romney and others are campaigning to repeal it at the federal level.
Repeal efforts cannot succeed as long as Mr Obama is President, since he would be able to veto any repeal Bill. Under a Republican administration a simple majority in both houses of Congress would be enough, but the history of big US welfare programmes suggests that, once granted, they quickly become too popular for politicians to retract.
The legal challenges are based on claims that under the so-called commerce clause of the US Constitution, government cannot force citizens to buy insurance.
In principle the Supreme Court might look kindly on such arguments, since it has a 5-4 conservative majority, but experts doubted that the court would relish the role of arbiter. Its nothing but trouble for the courts when they gainsay big acts of the legislative branch. It would make Bush v Gore look like a Sunday afternoon picnic if the Supreme Court invalidated this healthcare Bill, said Professor Larry Sabato, of the University of Virginia, referring to the presidential election recount of 2000.
And they dont want to go back to that. They went through Hell.
HIS NIBS
When President Obama signed the health reform Bill, many may have been surprised that he inscribed his name using 22 ceremonial pens.
It is part of a tradition that dates back many decades by which US presidents have often used multiple pens to sign important legislation so that they can give them as tokens of gratitude to people who worked for the Bills passage. With only 18 letters in Barack Hussein Obama and 22 pens, however, the President had to be creative with his pen strokes.
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