WASHINGTON Barack Obama now has a political triumph for the ages to burnish an already historic legacy, as the first president to fulfil the Democratic dream of health care for nearly every American.

Yet such is the rancour whipped up by the ferocious battle over the health reform bill sent to the president's desk by Congress on Sunday, the impact on Obama's political prospects and those of his Democratic allies is unclear.

Obama claimed a unique place in US history when his 2008 election win gave the United States its first black president.

Now, his victory on health reform, confirmed after a landmark House of Representatives vote on the most extensive social legislation in decades, has crowned a century-long, and oft-thwarted Democratic political crusade.

Supporters will make a case that Obama is the most significant reforming Democratic president since at least Lyndon Johnson, who pushed through health care for the poor and seniors and civil rights legislation in the 1960s.

Sunday's victory boosted a presidency launched with stratospheric expectations, but which had recently looked beleaguered, and allows Obama to argue he has delivered the change he promised.

“This is what change looks like,” a tired, but triumphant Obama said in late-night remarks in the White House after the vote.

“Tonight we answered the call of history as so many Americans have before us ... we did not fear our future, we shaped it.”

Some liberals say the bill does not go far enough, some conservatives brand it a job killing-government takeover over a huge slice of the economy, but no one disputes the significance of the legislation.

“I think we will look back on this being a historic vote,” said Dan Shea, a professor of political science at Allegheny College, Pennsylvania.

“It will change the relationship between citizen and government, and the role of government in medicine,” Shea said, of a bill which expands coverage to 32 million who lack medical care and regulates the mighty insurance industry.

Obama may reach the high point of his presidency when he signs the health care bill, still to be adapted by a later Senate vote, into law this week.

“Barring some major happening, I think this will likely be the most important moment of his first term, and even his presidency,” said Costas Panagopoulos, a political scientist at Fordham University.

Obama swept to power vowing to enact extensive political and social reforms, during the deepest economic crisis in generations, but was slowed by Republican obstruction and his own dwindling poll numbers.

So his healthcare win will enhance his authority within Washington and beyond, and after refusing to give up the battle, he now looks like a dogged reformer.

It may also boost his image abroad, where some observers had begun to wonder about the toughness of a president who can boast a Nobel peace prize but still awaits his first major foreign policy achievement.

The draft law, passed after Obama threw himself into the fray, after earlier being criticised for being too hands-off, will send shockwaves through the political establishment.

Some observers wonder whether there will be a price to pay and Sunday's vote marks the start of a new battle, to define the legislation.

The healthcare fight has left America even more polarized than when Obama took office in January 2009 and also spawned a vocal conservative “Tea Party” movement.

Even the idea of healthcare reform is now highly unpopular, after months of Republican attacks, legislative stalling, and political bile.

The White House argues that once the furore abates, Americans will embrace reform.

But conservatives hope Americans turn against the bill and strip away Democratic majorities in Congress at risk in November.

“This vote, and the passage of this legislation is not the end of the healthcare reform debate,” said Panagopoulos.

“Going into the 2010 mid-term elections, this will be the number one issue.”

Republicans brand the reform as a pernicious government takeover of the mostly-private US healthcare system.

Marco Rubio, a candidate for the Republican Senate nomination in Florida, took up that theme within minutes of the House vote on Sunday.

“This healthcare bill embodies all the things Americans have come to despise about our political system more spending, more regulation, backroom deals, secrecy, misinformation, flip-flops, politics over principles, demagoguery, pandering and broken promises,” Rubio said.

But the bill — though it fell short of a state health system many Obama supporters wanted — may also fire up the Democratic voting base.—AFP