After a year of political upheaval that swung from a triumphant Democratic sweep in Washington to the rise of the Tea Party movement, Congress on Sunday night sent to President Obama the most sweeping social program since Medicare was enacted in 1965.

The vote on the health care overhaul was 219-212, with not a single Republican supporting the measure.

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Before the final debate, House Speaker Nancy Pelosi of San Francisco locked arms with her Democratic lieutenants, including civil rights veteran John Lewis, D-Ga., to enter the Capitol through a phalanx of angry protesters. It was an emphatic show of solidarity after several ugly incidents on Saturday when demonstrators hurled racial slurs at several African American members of Congress and anti-gay insults at Rep. Barney Frank, the openly gay Massachusetts Democrat.

“We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans,” Pelosi told House members as she brought the debate to a close at 10:30 p.m. She invoked the memory of the late Sen. Edward Kennedy, whose death so complicated passage of reform, saying health care “is the unfinished business of our society, that is, until today.”

The health deal was sealed by early afternoon Sunday when anti-abortion Rep. Bart Stupak, D-Mich., secured an executive order by the White House that would reaffirm the long-standing Hyde Amendment banning taxpayer funding of abortions.

When fully implemented in four years, the landmark legislation would reshape one-sixth of the U.S. economy and expand health insurance coverage to nearly all U.S. citizens, including an estimated 8 million uninsured Californians.

Costing $940 billion for the next decade – about the price of the Iraq and Afghanistan wars so far – the bill is paid for with a combination of spending cuts and tax increases. It will require future Congresses to make tough decisions to ensure that its promise of $1.3 trillion in deficit reduction materializes over the next two decades.

In four years, it will require all Americans to carry insurance or pay a $700 fine. It will create a new federal entitlement of subsidies to help people shoulder the cost. Most people earning less than $200,000 a year are likely to see clear benefits, while those earning more than that will pay higher taxes. Small businesses will get a 35 percent tax credit to cover employees, and those employing fewer than 50 full-time workers will not be required to provide coverage. Larger employers, however, will pay fines up to $2,000 per worker if they do not provide coverage.

Republican-enacted Medicare Advantage plans that offer a range of extra benefits to the elderly beyond standard Medicare will be greatly cut back to help expand coverage to the uninsured.

The bill encompasses ideas dear to both parties – from a huge expansion of Medicaid to cover lower-income people, to the creation of an insurance exchange, or marketplace, where people will be able choose among a variety of private policies that suit their needs. It prohibits widely despised insurance-company practices such as denials of coverage to those with pre-existing illnesses and cancellations of coverage when people get sick. People will not be locked into their jobs for fear of losing their health insurance.

Broadly speaking, the bill is modeled on an overhaul implemented in Massachusetts in 2006, and will generally align the U.S. health care system more closely with those in several European countries, such as Switzerland and the Netherlands that provide universal coverage mostly through private insurers.

Amid all the heated debate over what the bill will or won’t do, what all experts agree on is that the current system, now consuming more than $1 of every $6 Americans earn, is bankrupting individuals, businesses and governments at all levels. Whether this overhaul fixes that, or how well or poorly it works, depends critically on its complex implementation and future battles to expand or roll back its reach.

As much as Democrats, Republicans have rolled the dice on health care, presenting an unbroken wall of opposition to what they described as a socialized takeover of health care that will ruin the country, in the words of House Minority Leader John Boehner, R-Ohio. For all their demonization of Pelosi, Republicans drew directly from her strategic playbook, in effect duplicating her rigid enforcement of party solidarity against former President George W. Bush’s attempt to add private accounts to Social Security in 2005 that helped lead her party to its majority.

Legislation is pending in some three dozen states to reject the health bill’s mandate and benefits. Republicans believe they will make big election gains in November based largely on the health care vote.

The risk they face – one that Pelosi has been pounding on all year – is that once a single final bill is enacted and its immediate benefits begin flowing to the public – the political tides will shift in favor of the legislation.

Republicans have their own experience to draw on: their precarious passage of a gigantic prescription drug benefit in 2003 that ballooned federal budget deficits and was enacted after an extraordinary 3 a.m. arm-twisting vote that was held open for an unprecedented three hours. Democrats battled that bill to its final moments, but on Sunday expanded it by closing a coverage gap in drug benefits to seniors.

Rep. Mike Thompson of St. Helena, a Democrat whose sprawling district contains plenty of fierce opponents of the health care legislation, said he had no problem supporting the bill.

“Sixty-three thousand people in my district don’t have health care,” Thompson said. “My friends and neighbors, my constituents, are going to see immediate benefits from this.”

Thompson said he got caught in a knot of protesters while walking from his office to the Capitol, and overheard two complaining that members of Congress had a secret underground tunnel to the Capitol, rode in big black SUVs and traveled with armed guards to avoid interactions with ordinary citizens.

“I was walking right next to the guy,” Thompson said, who complained of deliberate distortions of the bill over the past year. “I’ve got a 12- year-old Chevy that needs new ball joints. He’s welcome to come over and fix it.”

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