The US Senate today approved a package of changes to President Barack Obama's landmark healthcare reforms.
The House of Representatives is expected to give final approval to the changes later today and send them to Mr Obama for his signature.
The changes put the finishing touches on the sweeping healthcare reform bill signed into law this week by Obama, who visited Iowa today to launch a public relations blitz to sell the new program.
"This has been a legislative fight that will be in the record books," democratic senate leader Harry Reid said before the final vote.
Mr Obama warned Republicans, who uniformly opposed the overhaul and have vowed to make repealing the law a central issue in November's elections, that efforts to reverse the healthcare reforms would backfire.
"If they want to have that fight, I welcome that fight," Mr Obama said in his first big speech since enacting the most sweeping new U.S. social policy in decades.
"I don't believe the American people are going to put the insurance industry back in the driver's seat. We've been there already and we're not going back," he said.
The healthcare changes approved by the Senate on a 56-43 vote include an expansion of subsidies to make insurance more affordable and more state aid for the Medicaid program for the poor.
They also eliminate a controversial Senate deal exempting Nebraska from paying for Medicaid expansion costs, close a gap in prescription drug coverage for seniors and delay a tax on high-cost insurance plans.
The final package also would extend taxes for Medicare, the federal health insurance program for the elderly, to unearned income.
It also includes reform of the student loan program.
The overhaul of the $2.5 trillion healthcare system is the most dramatic revamp of health policy in four decades.
It will extend coverage to an estimated 32 million uninsured Americans and bar insurance practices like refusing coverage to those with pre-existing medical conditions.
Republicans have fought the measure as a costly government takeover of healthcare.
"This has been a somber week for the American people. With the stroke of a pen, President Obama signed away another share of Americans' freedom," Republican House leader John Boehner said.
But Mr Obama said he would be happy to engage Republicans in a debate over repeal of the law.
Reuters