March 22, 2010 -- Passage of the health care overhaul bill has sent ripple effects through the political world and the nation's health care system, with Democrats hailing a legislative victory and Republicans promising to have it overturned.
But the politics of the historic and controversial bill – which passed by a narrow vote of 219 to 212 – will continue to play out, as analysts examine where the chips fall on what President Obama has called the "tallies of Washington winners and losers."
Here's an early look by ABC News' political team on who stands to gain – and lose out -- in the wake of the new law and a bruising health care reform battle:
President Obama: It took over a year to pass and he used up a lot of political capital, but Obama's health care bill will be a defining legislative achievement of his presidency. White House chief of staff Rahm Emanuel and health reform director Nancy Ann DeParle are praised for seeing the effort through and for helping round up key Democratic votes, like those of Rep. Dennis Kucinich and Rep. Bart Stupak, in crunch time.
House Speaker Nancy Pelosi: Pelosi and her leadership team got the votes they needed to pass a Senate bill unpalatable to many House Democrats. Some members of congress and the administration had wanted the bill scaled back after Republican Sen. Scott Brown's victory in Massachusetts nearly derailed the legislation.
Labor Unions: Major labor groups led the charge to get universal health insurance back on the national agenda and helped shore up last-minute votes by threatening third-party challenges to Democrats who announced they would vote against the bill.
Pharmaceutical Industry: Drug companies cut a deal at the outset of the reform effort and largely avoided negotiation of drug prices as part of the overhaul bill.
Public Option Foes: Conservatives for Patients Rights and other opponents of any new government-run insurance program succeeded in killing the public option.
Uninsured Americans and People with Pre-existing Conditions: 32 million more Americans will have access to health insurance under the bill, and those who get sick will still be able to retain coverage. The measures effectively fulfill a campaign promise made by Obama and Democrats in 2008 campaign. Will these newly insured Americans turn out to vote their satisfaction?
Louisiana: The so-called "Louisiana Purchase" – a special provision in the bill that allocates $300 million in federal subsidies for Medicaid to Louisiana alone – survived revisions of the bill and helped secure the support of Democratic Sen. Mary Landrieu.
Pro-Life Democrats: Rep. Bart Stupak and other self-described "pro-life, whole life" Democrats got the president to sign an executive order clarifying that provisions of the bill are not to circumvent a long-standing ban on federal funding of abortion.
John Lewis and Barney Frank: By responding gracefully to racial epithets and homophobic slurs, Lewis, an African American and former civil rights leader, and Frank, the second openly-gay member of the House, helped marginalize protestors as being motivated by more than simple opposition to health reform.
Swing State/District Democrats: Democrats from states and districts with strident opposition to the bill could face difficult reelection campaigns in November and beyond as the health care vote is expected to be a top campaign issue. "We're going to have a very spirited campaign coming up between now and November, and there will be a very heavy price to pay for it," said Sen. John McCain, R-Ariz., on "Good Morning America."
Bipartisanship: The spirit of bipartisanship was dealt a blow when the landmark legislation passed without a single Republican vote. Similarly contentious bills, such as Medicare and Social Security, passed with large bipartisan majorities in their time. Sen. Max Baucus, D-Mont., spent a lengthy effort to cut a deal with Senate Republicans, and was once close to garnering the support of Maine's Olympia Snowe, among others, but that ultimately failed. "For the first time in history, we will have a major reform enacted without a bipartisan support for doing so," McCain said on "Good Morning America."
Tea Party Movement: Born out of opposition to Democrats' health care reform proposals, the vocal movement failed to leverage enough pressure on members to vote no, and the acts of a few prejudiced members who hurled racial epithets and homophobic slurs tainted their message.
Conservative Business Groups: The U.S. Chamber of Commerce and the National Federation of Independent Businesses spent millions fighting the proposed mandate on employers to provide health insurance for workers or face penalties. Their efforts failed.
High Wage Earners: Nobody likes to pay more taxes, but for individuals earning $200,000 or more and for couples earning $250,000 or more the bill will impose a new Medicare payroll tax by 2013.
"Young Invincibles": Young and healthy people who would prefer to go uninsured must now get insurance or pay penalties.
Public Option Supporters: Despite endorsement from the president and liberal members of his party, the government-run insurance option failed in the face of concerns about cost.
'Death Panels:' They weren't in the bill, and the threat of them didn't sink the bill.
State Budgets: Many states already cash-strapped will now face new costs under an expanded Medicaid program.
National Organization for Women: NOW says it is "incensed" over the president's executive order on abortion to appease pro-life House Democrats. They have attacked Obama as a sellout and expressed disappointment that he did not use the health bill as an opportunity to expand federal funding for abortion beyond the Hyde Amendment.
Catholic Bishops: The U.S. Conference of Catholic Bishops opposed the Senate bill for what it says would allow federal funding for abortion. They also criticized it for not doing more to provide immigrants access to health care. President Obama's eleventh hour executive order to appease pro-life House Democrats didn't sway the UCCB, which remains opposed to the bill.