The amendment bill, which included the fixes made to the Senate version of the health care bill, will now go to President Obama for his signature.

The Senate passed the legislation this afternoon by a 56-43 margin after defeating 41 amendments offered by Republicans.

Three Democrats, including Sens. Blanche Lincoln and Mark Pryor of Arkansas and Sen. Ben Nelson of Nebraska — all of whom voted for the original Senate health care legislation — voted against the reconciliation bill.

Members of the House had to vote again on the health care reconciliation bill because Senate Parliamentarian Alan Frumin ruled late Wednesday against some parts of the reconciliation bill dealing with Federal Pell Grants for low-income students.

Speaking at University of Iowa today, President Obama took several swipes at Republican critics of the health care law.

The president addressed those Republicans who have said they will run on repealing the health care law in the mid-term elections. “My attitude is: Go for it,” Obama said.

“Leaders of the Republican Party,” Obama said, “they called the passage of this bill ‘Armageddon.’ Armageddon. ‘End of freedom as we know it.’ So after I signed the bill, I looked around to see if there were any asteroids falling or some cracks opening up in the earth. It turned out it was a nice day.”

Obama spoke about how the changes in the health system will impact insurance companies.

“They’ve got to start playing by a new set of rules that treats everybody honestly and treats everybody fairly,” he said. “The days of the insurance industry running roughshod over the American people are over.”

It was Iowa City where in 2007 then-Sen. Obama first spoke about his vision for health care overhaul.

“Three years ago, we made a promise. That promise has been kept,” the president told the crowd, filled with students.

Polls show that the public is divided over the health care law, which the Congressional Budget Office estimated will cost $938 billion over 10 years and extend insurance to 32 million more Americans.

A USA Today-Gallup poll released Tuesday found that 49 percent of Americans said passing the health care bill was a “good thing.” Forty-two percent said they were angry or disappointed.

Outside Washington, D.C., people are channeling their anger against the health care law at their state representatives and vandalizing the offices of some of the lawmakers who voted in favor. Several lawmakers have asked for increased security both in Washington and outside their homes in their districts.

At the Democratic headquarters in upstate New York, someone threw a brick through the window with a note that read, “Extremism in defense of liberty is no vice,” a quote from Barry Goldwater.

Anti-abortion Democrat Rep. Bart Stupak, D-Mich., who struck a deal to vote for the health care bill in exchange for an executive order from Obama, has been the subject of threatening phone calls calling him “Baby killer” and wishing he would die. In one letter he received, there was a drawing of a hanging noose with Stupak’s name written on the gallows. At the bottom it read, “All baby killers come to unseemly ends either by the hand of man or by the hand of God.”

There have been so many cases of vandalism and angry phone calls that the FBI is now trying to figure out whether angry words will actually translate into violence.

Such actions “have no place in the civil debate in our country,” House Speaker Nancy Pelosi, D-Calif., said today.

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House Democrats approved the same package Thursday evening, 220 to 207, formally concluding the tortuous 14-month drive to move major healthcare legislation through Congress for the first time since Medicare’s creation in 1965.

” Franklin Roosevelt identified four freedoms: freedom of religion, freedom of speech, freedom from want and freedom from fear,” said Sen. Christopher J. Dodd (D-Conn.), one of the architects of the healthcare overhaul.

“Today in many ways we are fulfilling that last of the great freedoms, the fear that you or your family could suffer a healthcare crisis.”

The president, who traveled to Iowa on Thursday to tout the healthcare overhaul, is expected to the sign the bill in the next several days.

Paralleling earlier healthcare votes this year, not a single Republican voted for the final package in the House or Senate.

Many GOP lawmakers have criticized the legislation as an unwarranted expansion of federal authority over healthcare. And Thursday, Republicans kept up their call to roll back the legislation, previewing a heated debate that is expected to intensify as election day approaches this fall.

“The important thing now . . . is to replace those who voted for the healthcare bill and to repeal it when we get some new members here,” Sen. Jim DeMint (R-S.C.) told Fox News Channel’s Sean Hannity.

Three Democrats in the Senate and 32 in the House also voted against the package Thursday. Sens. Blanche Lincoln and Mark Pryor of Arkansas and Ben Nelson of Nebraska joined 39 Republicans. Sen. Johnny Isakson (R-Ga.), is hospitalized and did not vote.

The bill needed only a simple majority in the Senate because Democrats used the budget reconciliation process to avoid a filibuster, which requires a 60-vote supermajority to quash.

The 153-page reconciliation package represents a small fraction of the gargantuan healthcare legislation that the House approved over the weekend and the president signed Tuesday.

But it makes several major changes to the main healthcare bill, including expanding subsidies that the federal government will provide to low- and moderate-income Americans starting in 2014 to help them buy health insurance.

The package also scales back a new 40% excise tax on high-end “Cadillac” insurance plans and delays that tax until 2018.

It imposes a new levy on couples making more than $250,000, who will pay a 3.8% Medicare tax on capital gains and other investment income for the first time.

The bill boosts federal aid to states to help them expand their Medicaid programs, replacing a provision in the main healthcare bill that singled out Nebraska for special assistance.

And it would gradually close the gap in Medicare prescription coverage known as the “doughnut hole,” which forces millions of seniors to pay thousands of dollars for medications out of their own pockets. Within a year, beneficiaries whose initial drug benefits ran out would receive a $250 rebate, and by 2020, the doughnut hole would be gone.

Together, the reconciliation package and the healthcare legislation are expected to cover an additional 32 million Americans by 2019, boosting the percentage of non-elderly Americans with insurance to 94% from 83%, according to estimates by the nonpartisan Congressional Budget Office.

The legislation also establishes a broad new framework of government regulation to prevent insurance companies from denying coverage to people who are sick and to require insurers to provide a minimum level of benefits.

The coverage expansion would not be cheap, requiring an estimated $938 billion over the next decade to expand Medicaid, give tax credits to small businesses to help them cover their employees, and provide insurance subsidies to many Americans who do not get benefits at work.

For the first time, most Americans will be required to carry health insurance or pay a penalty.

Because the cost of expanding coverage is offset by new taxes and cuts in what Medicare will pay insurers, hospitals and other providers over the next decade, the Congressional Budget Office estimated that the legislation will reduce the deficit slightly by 2019 by an estimated $143 billion.

Republicans have repeatedly criticized the new taxes and Medicare cuts.

And over a day and half of almost continuous voting on amendments, GOP senators tried to get Democrats to remove sections of the bill designed to raise revenue to pay for the legislation.

In the end, however, a provision unrelated to healthcare almost tripped up the measure.

The reconciliation bill includes a major change in the way the federal government helps students pay for college, giving the government authority to lend money to students directly instead of using private financial institutions as intermediaries. The student loan section of the legislation would use part of the projected savings from this change to expand the federal Pell Grant program for low-income students.

But very early Thursday morning, Republicans successfully objected on parliamentary grounds to a minor provision designed to prevent the Pell Grants from decreasing in periods of deflation. The provision did not reduce the deficit, as required by the budget rules.

That forced Democrats to change the package, which in turn forced the House to take it up again Thursday even though the chamber had approved an earlier version Sunday.

A spokeswoman for the House Education and Labor Committee said Democrats may add the provision to legislation in the future if there are any signs of deflation.

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Democrats will now proceed with a straight up-or-down vote on the healthcare bill that passed the Senate last year. Party leaders, facing the possibility of failure, decided Saturday to scrap plans to use a controversial procedural maneuver to approve Senate legislation.

The House plans to begin voting on the Senate bill Sunday afternoon. It will also hold a second vote Sunday on a package of amendments to modify some provisions of the Senate legislation and expand its scope to satisfy demands from House Democrats.

Barring a last-minute breakdown over abortion, House Democrats are expected to have the 216 votes they need.

Democrats rallied around the plan after an emotion-filled day on Capitol Hill during which President Obama delivered a fiery speech that brought lawmakers to their feet in support of the overhaul. Outside, thousands of angry protesters gathered, calling on lawmakers to “kill the bill.”

The last-minute decision Saturday to vote directly on the Senate bill undercut a Republican argument that Democrats were abusing House rules and procedures in their eagerness to pass the healthcare overhaul. The decision also appeared to swing several key lawmakers behind the legislation Saturday, including Rep. Dennis Cardoza (D-Atwater), a member of the fiscally conservative House Blue Dog Coalition.

“We are on the verge of making great history for the American people,” House Speaker Nancy Pelosi (D-San Francisco) told her Democratic colleagues at the meeting with Obama that turned into a spirited rally.

During his speech, Obama reminded lawmakers of the historic opportunity at hand.

“Don’t do it for me. Don’t do it for the Democratic Party,” the president said. “Do it for the American people. They’re the ones looking for action right now.

“I know it is a tough vote,” Obama said. “And I am actually confident . . . it will end up being the smart thing to do politically, because I believe that good policy is good politics.”

Senate Majority Leader Harry Reid (D-Nev.) also promised that he had the 51 votes needed to pass the amendments package, which will be presented in the form of a filibuster-proof budget reconciliation measure as soon as Monday.

As Democrats worked inside the Capitol, tensions continued to mount outside, and protesters flooded into the buildings where lawmakers have their offices.

Rep. Andre Carson (D-Ind.) said he and Rep. John Lewis (D-Ga.), both of whom are black, were accosted outside the Capitol by one group of protesters who shouted racial epithets at them.

“It was like a page out of a time machine,” Carson said outside the House chamber Saturday afternoon.

The demonstrators, many with conservative “tea party” groups, carried signs reading: “Government is the problem, not the solution.”

The 10-year, $940-billion healthcare package is expected to extend medical insurance coverage to about 32 million people by 2019, while also using a series of tax hikes and cuts in Medicare spending to reduce the overall federal deficit by $138 billion over the next decade, according to a preliminary estimate by the nonpartisan Congressional Budget Office.

The House plans to begin voting Sunday afternoon, unless Republicans try to use parliamentary rules to delay the vote. GOP lawmakers pledged Saturday to continue fighting the legislation, which they say will drive up government spending and healthcare costs.

“This weekend, House Republicans will stand with the American people and do everything in our power to defend their freedom and bring about healthcare reform that gives them more freedom and not more government,” said Rep. Mike Pence of Indiana, the No. 3 House Republican.

If passed, the Senate bill would go to Obama for his signature and the package of amendments would go to the Senate for its approval.

If the Senate passes the amendments package without any changes, it too would go to Obama for his signature. Democratic officials concede, however, that the Senate may alter the package, which would require yet another House vote on the changes — but not on the healthcare overhaul as defined in the Senate bill.

The legislative endgame came into focus Saturday after a flurry of last-minute negotiating and cajoling. Pelosi and her lieutenants rushed between their offices and the House floor to settle lingering disputes among rank-and-file Democrats.

The leaders intensely worked with administration officials to satisfy demands from a small group of antiabortion lawmakers who wanted to place tough restrictions on federal funding for abortion services.

Senior Democrats were exploring whether the president could issue an executive order to clarify that the healthcare legislation would not allow any taxpayer money to be used for abortions and to further protect doctors and other medical providers who choose not to provide abortion services.

“It may be all that’s left,” said Rep. Marcy Kaptur (D-Ohio), a socially conservative lawmaker among the group of holdouts led by Rep. Bart Stupak (D-Mich.) who said they could not support the legislation without more abortion restrictions.

Other social conservatives say they are satisfied that the bill’s language is sufficiently restrictive to ensure that women who receive federal insurance subsidies would not be able to use them to pay for abortion services.

The Senate bill currently requires women who buy subsidized insurance plans that cover abortion services to send their insurer a separate check to cover the abortion benefit.

Working with administration officials, a group of lawmakers from rural districts also hammered out an agreement to boost how much Medicare pays rural doctors and hospitals, a key issue for many legislators. Under the terms of the agreement fleshed out in the early hours of the morning, the Department of Health and Human Services would develop a permanent fix over the next two years.

“You can’t do much better than that,” said Rep. Peter A. DeFazio (D-Ore.), who spoke with the president Saturday to help seal the agreement. DeFazio said he would back the bill.

Other Democratic holdouts who declared their support Saturday included Reps. Jim Costa of Fresno, Christopher Carney of Pennsylvania and Gerald E. Connolly of Virginia.

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“Don’t do it for me,” Obama said. “Don’t do it for the Democratic Party. Do it for the American people. They’re the ones looking for action right now.”

“I’ve been in your shoes,” said Obama, a former U.S. senator and state legislator. “I know what it’s like to take a tough vote. But what did Lincoln say? ‘I am not bound to win, but I am bound to be true.’”

Obama described the current health care proposal as “a middle-of-the-road bill to help the American people in an area of their lives where they urgently need it,” and suggested a yes vote in the face of near-unanimous Republican opposition is a test of character many voters ultimately will appreciate.

“Good policy is good politics,” Obama said. “Ultimately, the truth will [win] out.

“This is one of those times where you can honestly say to yourself, ‘Doggone it, this is exactly why I came here; this is why I got into politics,’” he said.

Outnumbered Republicans felt differently — and angled for any advantage they could find. In a nearly unprecedented move, Republican leaders allowed reporters into a private strategy session.

“Now we’re there,” said House Minority Leader John Boehner, R-Ohio. “We’re about 24 hours from Armageddon.

“This health care bill will ruin our country,” Boehner added later. “Time to stop it.”

Democrats claim they have the momentum to pass a Senate bill with modifications through the House of Representatives on Sunday.

If they succeed, the Senate then would have to vote for reconciliation to approve the changes.

“I have the commitment of the U.S. Senate to make that good law even better,” he said.

Democratic Party leaders today said they would drop an idea of voting on the Senate bill and the amendments together through a process called “deem and pass” after Republicans accused them of backhanded maneuvers. Instead, Democrats will hold a direct up-or-down vote for each bill.

“Clearly, we believe we have the votes,” said Rep. Steny Hoyer, D-Md.

However, ABC News counted 212 likely votes in the House for the latest proposal on health care reform and 214 leaning against it — including two Democrats who clarified their stance after Obama’s Capitol Hill appeal.

The two new “no” votes were Rep. Zack Space of Ohio, who voted for an earlier version of health care reform, and Rep. Jim Matheson of Utah, who had voted “no” on an earlier version, but had been on the Democratic leadership committee’s list of possible switches.

House Republicans appear unanimously opposed to the reforms.

It will take 216 votes to pass or defeat the health care legislation. A vote can take place any time after 2:07 p.m. Sunday.

Still not committed either way is Rep. Bart Stupak, D-Mich., the leader of a Democratic faction that wants stronger anti-abortion language in the legislation.

Some Democrats seemed to believe they could pass the bill without further changes to appease Stupak.

“We’ve compromised enough,” said Rep. Diana DeGette, D-Colo. “The bill’s not going down.”

But Republicans also are wooing undecided Democrats. And though they don’t have the votes to defeat the measure on their own, they are trying to make as much noise as possible.

They got some help today as thousands of the Republican faithful and other health care reform opponents filled the steps of the U.S. Capitol.

However, in some cases, the opposition got ugly.

Democrats claimed a protester spat on Rep. Emanuel Cleaver II, D-Mo., and referred to Rep. John Lewis, D-Ga., with a racial epithet. A spokesman for Cleaver said a suspect was arrested but the congressman declined to press charges.

In addition, officials said anti-gay epithets were hurled at Rep. Barney Frank, D-Mass.

Republicans focused their lobbying efforts on approximately 15 Democrats viewed as swayable.

Rep. Charles Boustany, R-La., who is a doctor, was working on some of the freshman Democrats.

“It’s very fluid right now and we’re going to continue to work,” he said, adding that Republicans were doing “anything we can do to bring the pressure to bear to get them to think about what the implications are for a yes vote.”

The only Republican who voted for an earlier House version of health care reform reluctantly flipped.

“Tomorrow will be a sad day for me as I cast a no vote against something I believe we need, to prevent the expansion of abortion,” said Rep. Anh Cao, R-La.

One Republican has accused the administration of offering jobs to Democrats who flip to yes votes and then lose in the November elections. A Republican senator issued a warning to Democrats, saying if that scenario plays out, he will block any nomination that comes before the Senate.

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