Senate Majority Leader Harry Reid, left, and Sen. Chris Dodd (D-Conn.) celebrate after the Senate approves a package of changes to the health care bill. Health bill clears Congress

Congress completed its work Thursday night on the broadest social legislation in almost a half-century, as the House capped the yearlong legislative saga over health reform by signing off on a package of fixes to the newly minted law.

In the end, the titanic battle over remaking the American health care system drew to a close on a pair of votes drained of suspense — after the Senate approved the cleanup bill earlier Thursday. The House approved the same bill, 220 to 207.


The votes deliver twin victories to President Barack Obama, the health care overhaul on which he staked the first year of his presidency and a lesser-noticed provision that would carry out a major restructuring of the student loan industry.

“The benefits for Americans start right now,” said Rep. George Miller (D-Calif.), the chairman of the House Education and Labor Committee, who also cited changes to the student loan system that Democrats included in the health reform cleanup bill. “That’s the road to prosperity. That’s the road to freedom for America’s families.”

But Republicans warned that Obama had overreached in his effort to pass the bill, which employed fast-track rules to get around the possibility of a Republican filibuster.

“The American people are asking, where are the jobs, but as we see today, the issue of government-run health will continue to be the focus on this body,” said House Republican leader John Boehner of Ohio. “We’re going to be back here fixing the flaws in this very flawed bill.”

With Vice President Joe Biden presiding over the chamber, the Senate took the first step Thursday, passing the package of fixes, 56 to 43. But the work wasn’t done quite yet.

That’s because the last bit of drama on health reform had actually occurred early Thursday morning, when Republicans succeeded in finding two parts of the reconciliation bill that didn’t pass muster with the Senate parliamentarian, both regarding Pell grants for low-income students.

So the version passed by the Senate had to be passed again by the House — even though the House had already passed the landmark legislation Sunday night that Obama signed on Tuesday. But since both houses must pass identical versions of legislation to send it to the president’s desk, the House had to return for one final vote, with members nervous over any last-minute blow-ups that could endanger the reconciliation bill.

In the Senate, three moderate Democrats voted against the reconciliation bill — Nebraska’s Ben Nelson and the two senators from Arkansas, Mark Pryor and Blanche Lincoln. Lincoln faces a tough reelection fight this fall. Republican Johnny Isakson of Georgia is ill and wasn’t in the chamber.

No Republicans voted for the reconciliation bill in the House or the Senate, after just one Republican, Anh "Joseph" Cao of Louisiana, voted in November for the underlying health reform law. Sen. John McCain (R-Ariz.) criticized the measure until the end, saying, “It is the most unsavory sausage-making, Chicago-style bill I have ever seen.”

He said the GOP mantra would be to “repeal and replace” the bill going forward. “We can’t just have the status quo,” McCain said.

The Senate vote happened just as Obama took the stage in Iowa City, Iowa — his first stop since he signed the legislation Tuesday — hoping to promote the bill to the American public, which polls show is deeply skeptical of reform. He told Republicans he welcomed the chance to debate them on the merits of the plan, particularly if they insist on pressing for a repeal of the law.

“My attitude is: Go for it,” Obama said. “If these congressmen in Washington want to come here in Iowa and tell small-business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest.”

The reconciliation bill makes a variety of fixes to the health legislation. It removed controversial deals such as the Cornhusker Kickback and also pushes off implementation of an excise tax on high-cost “Cadillac” health plans until 2018.

The final vote on reconciliation in the Senate came with little drama — but it followed weeks of tough negotiations between House and Senate Democrats over what should be in it and whether there would be the votes to pass it.

The top leaders in the Senate, Democratic Majority Leader Harry Reid and his counterpart, Minority Leader Mitch McConnell, worked out a deal in the early morning hours Thursday to hold the vote at 2 p.m. — and it went off on time, with the final outcome not in doubt.

Sen. Robert Byrd (D-W.Va.), the longest-serving senator, was wheeled into the chamber by an aide and shook hands with Reid before going to his place and waiting for his name to be called in the roll. There was a humorous moment when Reid’s name was called, and he said ‘no,’ before quickly correcting himself. He made the same mistake when the Senate voted on the overall health reform bill on Christmas Eve. The chamber broke out in laughter.

The legislative path that brought the Senate to Thursday’s vote was tortuous and politically risky.

The Senate spent months trying to write a bill that could win 60 votes. Democrats succeeded on Christmas Eve, only to lose their filibuster-proof majority a month later.

The White House and congressional leaders revived the bill after deciding on a two-step process — the House passing the Senate bill, followed by both chambers using fast-track rules known as reconciliation to pass a package of fixes. This was the only way House members would agree to approve the Senate bill and the only way the Senate could make changes that the House wanted.

Reconciliation was fraught with challenges. But Democrats successfully scrubbed the bill of any potential procedural land mines, preventing Republicans from stripping out any major policy pieces that would have endangered its passage in the House or the Senate.

Democrats also held together during the more than 13 hours of amendments, turning each one back. While Republicans implored their colleagues to make changes, Democrats argued that any changes would send the bill back to the House for another vote, an outcome they worked mightily to avoid before the parliamentarian’s ruling early Thursday. That meant Democrats had to vote against such campaign ad fodder as a provision barring sex offenders from being given Viagra.

Once Republicans struck two minor provisions from the bill, sending it back to the House, some liberals suggested that Democrats had one last chance to fight for the public option. But no senators took the bait.

Democrats insisted on keeping the bill as clean as possible so the House could give the measure swift approval — and then the party could be done with the health care debate once and for all.

Senate Budget Committee Chairman Kent Conrad (D-N.D.) said, “Everybody feels committed, feels we’ve done the right thing, knows that the things that are required to go back to the House are insignificant and the House has already told us, ‘No problem.’ So we don’t want to change that.”

The drama playing out on the Senate floor eventually became a battle of wills between Republicans and Democrats, with each side trying to outlast the other.

By the time senators filtered into the chamber Thursday afternoon, the final vote felt almost anticlimactic to Democrats who had expended so much energy to get to that point.