WASHINGTON -- With the strokes of 22 pens, a buoyant President Barack Obama on Tuesday signed into law the most far-reaching health care overhaul in two generations, vindicating a yearlong struggle in which he staked his presidency on a promise to overcome ferocious opposition and begin to transform the nation's health care system.
In a crowded White House ceremony that was both partisan celebration and recognition of history in the making, House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., raised their arms like victors at a pep rally.
Vicki Kennedy, widow of the late health reform champion and Massachusetts Sen. Edward M. Kennedy, blew a kiss, and Vice President Joseph R. Biden -- as he embraced Mr. Obama -- was caught by an open microphone using an obscenity, exclaiming: "This is a big ... deal."
Mr. Obama said the moment was proof that a polarized political system often the target of national ridicule could still produce substantial change to help everyday people.
"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 of America," he said. "It is fitting that Congress passed this historic legislation this week. For as we mark the turning of spring, we also mark a new season in America."
Mr. Obama spoke from a lectern in the East Room, surrounded by congressional Democrats and guests who played parts in the law's adoption. So ebullient was the mood that guests all but lifted Ms. Pelosi onto their shoulders and shouted "Nancy! Nancy! Nancy!" as she was introduced by the president.
Both Vicki Kennedy and Mr. Obama wore blue plastic wristbands that said, "TedStrong"; the bands had been distributed last summer by Massachusetts Democrats as a sign of support for the senator during his final battle with cancer.
And Mr. Obama gave a wide-swinging handshake to Rep. Dennis Kucinich, D-Ohio., a target of presidential arm-twisting who switched his vote from no to yes in the final days.
An administration official later described Mr. Biden's gaffe -- whispered into Mr. Obama's ear as the two embraced but picked up by the microphone, as "rational exuberance."
Standing in front of the majestic red carpet leading into the East Room, Mr. Obama said: "With all the punditry, all of the lobbying, all of the game-playing that passes for governing in Washington, it's been easy at times to doubt our ability to do such a big thing, such a complicated thing; to wonder if there are limits to what we, as a people, can still achieve. It's easy to succumb to the sense of cynicism about what's possible in this country.
"But today, we are affirming that essential truth -- a truth every generation is called to rediscover for itself -- that we are not a nation that scales back its aspirations."
After his remarks, Mr. Obama sat down at a small table and signed the bill, using two pens for each of the 11 letters in his name. Twenty of the pens would go out as souvenirs, with two reserved for his presidential archives.
With the multiple pens' strokes, Mr. Obama achieved something that had eluded presidents since Theodore Roosevelt in the 20th century's first decade -- winning congressional approval of a wide-ranging overhaul of health care.
And he made good on a May 2007 pledge in Iowa City, when -- as a first-term senator from Illinois and underdog presidential candidate -- Mr. Obama first rolled out a plan to cover millions of uninsured Americans.
The signing ceremony was packed with Democratic lawmakers who have spent the past year writing, shaping and arguing about a health care bill that consumed Washington and forced other legislative priorities to the back of the line.
On Capitol Hill, not one Republican had voted to make the Senate blueprint the law of the land. Underscoring the partisan divide, not one GOP lawmaker was present in the East Room; the White House extended invitations only to those who voted for the bill.
In his address, the president emphasized that people will see improvements in their health care coverage soon. "It will take four years to implement fully many of these reforms, because we need to implement them responsibly," he said. "We need to get this right. But a host of desperately needed reforms will take effect right away."
The new health care system will unfold in stages. Within 90 days, a national high-risk insurance pool will be created to provide interim coverage for uninsured adults with pre-existing conditions.
In six months, insurers will be banned from placing lifetime limits on coverage and from rescinding policies, except in the case of fraud. Dependent children up to age 26 will have the option of remaining on their parents' plan. And insurers will be required to cover children with pre-existing conditions.
Starting in 2014, state-based insurance exchanges will provide a regulated marketplace for consumers to compare policies that must meet federal standards. Also at that point, a requirement kicks in for individuals to carry insurance.
Even as the celebration proceeded in Washington, Congress labored to complete the overhaul with a companion measure containing changes demanded as a condition for House Democrats' approval. The Senate was poised to consider that bill, with Democratic leaders hoping for its completion by week's end.
Months of partisan fighting and debates about legislative process have taken a toll. Mr. Obama's job approval rating dropped 20 points as the health debate played out. Congress' approval rating is in the teens.
But a fresh wave of polling shows the public seems to be warming to the plan. A Gallup poll released Tuesday showed that 49 percent believed that passage of the bill was "a good thing," compared to 40 percent who labeled it "a bad thing."
While many Republicans are calling for repeal of the legislation, some are tempering that message by saying they would retain some of the more popular elements that Mr. Obama is showcasing, rather than return to the status quo ante.
"With him over the next few weeks being Mr. Salesman and telling people how great the bill is, a repeal argument is insufficient," said Sen. John Thune, R-S.D. "You have to tell people how you will fix it."
The law faces other challenges. Shortly after the signing ceremony, more than a dozen Republican state attorneys general opened a challenge to the law's constitutionality. They contend that the requirement that everyone purchase health insurance violates the Constitution's commerce clause.
The White House predicted that the new law would hold up, but is girding for a legal fight.
Democrats also worry that the public may exact revenge in the midterm elections.
The Associated Press contributed.