219 to 212.

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After a year of intense vivid and vehement debate, false deaths, and death panels, arms twisted, heads counted and brains whipped, with the fate of their majority in Congress in the balance, Democrats sent to President Obama Sunday night the largest revision to the American health care system in half a century. 


They did so with a narrow margin, with 219 votes; 216 were needed. 

After that history-making vote, the Democratic caucus was poised to easily dispatch a motion to recommit the bill back to its committee, and then a smaller billet of fixes to the bill that Democrats are trusting the Senate will pass later in the week. 

This is a day -- perhaps the first day since November 4, 2008 or January 20, 2009 -- that Democrats working in Washington can point to when they weigh whether the disruption to their family lives, friendships and psyches are worth the travails.  Just two months ago, this bill was as good as dead. And then Democrats changed strategies, and Republicans overreached. President Obama took risks and led.

In the two hours of grandstanding and sloganeering before the vote, punctuated by interruptions from the gallery full of young staff members and activists, Republicans used apocalyptic language to describe the consequences. Several blasted the Democrats as liars for claiming that the bill would reduce Medicare in the long-term because the legislation double-counts potential savings.  A "step towards socialized medicine," said Rep. Mike Pence (R-IN), before quoting Scripture.  Rep. Paul Ryan (R-WI) skipped his usual litany of policy points to argue that the bill represented a fundamental departure from the American way.  Speaker Nancy Pelosi enthused that her members were of the caliber of those who voted into law Social Security and Medicare. The majority whip, James Clyburn, called it the "civil rights act" of the 21st century.

The clearest sign that Republicans understood that they were on the verge of losing the health care reform battle: the tone of Republican leaders on the Sunday shows. They'd moved from the politics of the legislative process to the politics of the 2010 elections. They were fighting as if they believed the bill will become more popular. Minority Leader John Boehner called it: "Armageddon." He had a "sad and heavy heart" when he rose to speak before the chamber at a few minutes after 10:00 pm ET. 

Passage became official, sort of, with Bart Stupak's agreement on abortion, announced at 4:00 p.m., bringing the official "yea" vote tally to 215 and the unofficial vote tally (as counted by the White House and Democratic leadership) to 220.  A few key Democrats said they changed their votes because of grassroots pressure.  Rep. Brian Baird of Washington told Talking Points Memo that at least half of the in-district calls to his office on Friday came from supporters of reform. (Organizing for America, the campaign arm of the Democratic National Committee, estimates that its e-tools were responsible for about 600 of the 850 pro-reform calls originating inside the district.)

Mr. Stupak, meanwhile, was denounced by pro-life leaders. The Susan B. Anthony Fund announced that he was no longer considered a "defender of life."

52 Senate Democrats have signed a letter promising to support the House reconciliation language as-is; Republican Sen. Jon Kyl has promised to "drag this out forever with amendments." Many of them will be deceptively tempting for Democrats, the idea being that Republicans want to change the reconciliation billet so to render it unacceptable to the House. 

Open questions include the timing of the new executive order  on abortion -- the timing of the Senate vote (debates start Tuesday), and whether there will be any modifications to the reconciliation package (in which case the House needs to vote again), and when President Obama decides to formally deem health care passed by having a public event memorializing the accomplishment. (Probably not until the reconciliation process is well on its way -- later in the week, according press secretary Robert Gibbs.)

So -- the big GOP talking point today -- that the Senate bill will be the law of the land at the end of the day -- was true (Ranking Rules member Rep. David Dreier and Rules Committee chair Rep. Louise Slaughter engaged in very heated arguments about this) -- but the Democrats, based on the promise from Harry Reid to pass the House reconciliation language and the Obama executive order -- despite everything in their brains and their history telling them to the contrary, are going to ignore this.

A Republican Senate aide said that the House reconciliation bill will be subject to a point of order once it reaches the Senate, and that's probably true -- and a negative ruling by the parliamentarian would mean that Democrats voting for the Senate bill will be stuck with it without the changes.  Democrats are planning to swallow the hiccup, but it's likely the reconciliation bill won't be too far away from the president's desk.   It may be risky for Republicans to oppose the reconciliation provisions because they "fix" the depredations that Republicans complained about. 

Democrats are going to stress the parts of the bill that kick in immediately, including small business tax cuts, closing the Medicare donut hole, allowing adult children up to the age of 26 to stay on their parents' health care plans, insurance industry reforms (ending recissions), free preventative, and temporary coverage for early retirees, among others.

Republicans hope that the unpopularity of the bill will endure. "What they see is one political party closing out another from what should be a bipartisan solution," said Boehner. "Shame on us, shame on each and every one of you who substitutes your will and your desires for those of your fellow countrymen."

The House Democrats will try to sell the bill over the recess as a massive jobs creator -- and they'll take up the Build America Bonds extension bill at the same time.  Expect to hear Democrats talking about the deficit reduction that the CBO attributes to the bill, and even to make a push that, as April 15 comes around, the stimulus package included plenty of tax cuts and is responsible for kickstarting the economy.

Democratic allies plan to punish Democrats who opposed the bill. Anna Burger, president of the Change to Win union federation, said that Rep. Jason Altmire (D-PA) should expect a primary challenger because of his no vote. And she hopes the momentum from the health care fight will convince Americans Democrats can govern. "We've got to be a constant drumbeat to make things change," she said.

Republicans had bet that throwing everything into to killing the bill instead of working with it would result in the bill's defeat. The entire strategy was predicated on killing the bill. Now that the bill has passed, it means that the health care system has been fundamentally changed, and there's no way -- and there will not be the votes -- to repeal it. No one will tell seniors that the donut hole will be opened up, or people promised new insurance that they'll have to look elsewhere, or that rescission will once again be legal.  Democrats will work for to force Republicans to talk about repeal as often as possible.

"Everything changes," a senior administration official said tonight. What that means in practice remains to be seen. Privately, Republicans predict that President Obama's favorability ratings will rise at least five points and fortify Democrats in upcoming policy disputes about financial reform, education reform and immigration reform.
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Marc Ambinder is an Atlantic contributing editor. He is also a senior contributor at Defense One, a contributing editor at GQ, and a regular contributor at The Week.

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