The historic US healthcare reform law, which extends coverage to 32 million more Americans and enshrines health care as the right of every citizen, has passed its final Congress vote.
The US House of Representatives endorsed amendments to the legislation in a 220-207 vote, clearing the way for President Obama's signature on the second of two bills that marked the culmination of what the president called "a year of debate and a century of trying" to ensure coverage for nearly all in a nation where millions lack it.
Mr Obama is expected to sign the legislation early next week.
Taken together, the two bills also aim to crack down on insurance industry abuses and to reduce federal deficits by an estimated $143 billion over a decade. Most Americans would be required to buy insurance for the first time, and face penalties if they refused.
The second of the two bills also presented President Obama with another victory, stripping banks and other private lenders of their ability to originate student loans in favour of a system of direct government lending.
Apart from their impact on nearly every American and an estimated one-sixth of the American economy, the week's events marked Mr Obama's biggest political triumph since he took office more than a year ago. A pending arms control agreement with Russia, announced on Wednesday, added to his resume, and White House officials said they hoped the momentum would translate into further political successes in the run-up to the midterm elections.
Following Sunday's vote, more than 10 supporters of the legislation said they had received threats or worse as a consequence of the health care debate. There were reports of bricks through windows, a cut propane line to a grill and numerous obscene and threatening phone calls and faxes. An undisclosed number have been given increased police protection.
Speaker Nancy Pelosi and the Republican leader, Rep John Boehner of Ohio, both denounced the threats and incidents of violence. But Democrats said Republicans had been too slow to respond, drawing an outraged response in return.
"By ratcheting up the rhetoric, some will only inflame these situations to dangerous levels," said Republican Whip Eric Cantor of Virginia. "Enough is enough. It has to stop."
An aide to Rep Chris Van Hollen of Maryland, head of the Democratic 2010 campaign effort, responded: "This is straight out of the Republicans' political playbook of deflecting responsibility and distracting attention away from a serious issue."
"Repeal and replace" was the new slogan for Republicans as they pivoted away from earlier attempts to kill the health care legislation. Officials said it was meant to appeal to tea party activists - who staged an occasionally unruly demonstration outside the Capitol over the weekend - as well as to independent voters eager for changes in the health care system but fearful the Democrats went too far.
"Republicans fought on behalf of the American people this week and will continue to fight until this bill is repealed and replaced with commonsense ideas that solve our problems without dismantling the health care system we have and without burying the American dream under a mountain of debt," said Senate Republican leader Mitch McConnell of Kentucky.
The Senate vote took place with Vice President Joe Biden presiding, a symbolic gesture since his vote was not needed.
Moments before approving the legislation, the Senate paused for a moment of silence in memory of Sen Edward Kennedy of Massachusetts, who died last year after a career of more than 45 years in which he relentlessly pursued legislation to enact national health care.
AP