Barack Obama put everything into this battle, fighting Republicans as well as wavering members of his own Democrat camp.
His sweeping overhaul offers coverage to almost all Americans and reduces the enormous cost healthcare represents in the United States.
At the moment the over 65s, just over 15 per cent of the population, are covered by Medicare. Medicaid goes to the 13 per cent of the population with the lowest incomes. Both schemes are government-funded.
The majority- 58 per cent- have employer-funded insurance, while 15 per cent have no coverage at all.
The United States currently spends more than two trillion dollars a year on healthcare. That was 16 per cent of GDP in 2007, and is set to rise to 20 per cent by 2015.
Central to the problem has been the exorbitant levels of contributions. An average American who fell ill risked being ruined by the cost of treatment, especially if they lost their job and became unable to pay.
The reforms set out to cover around an extra 31 million uninsured Americans. It will cost 940 billion dollars over 10 years. But by tackling waste, fraud and abuse, it should reduce the federal deficit by 138 billion dollars over the same length of time.
As part of the overhaul, insurers will be barred from excluding people for pre-existing conditions and prevented from arbitrarily dropping policy holders.
Insurance exchanges will be created where small businesses and individuals without work-related provision will be able to shop for coverage. Plans offered on the exchange will have to meet minimum benefit requirements.
The package has proved a difficult pill for Congress to swallow and for many it’s been regarded as a make or break milestone for Barack Obama’s legislative agenda.