By Paul Adams
BBC News, Texas
After months of bitter, rancorous debate, Washington has delivered. A healthcare reform bill is on the statute.
Margaret Torres has had a difficult time since losing her health insurance
In faraway Houston, it feels like a benediction to Margaret Torres.
In her spartan, one-room house, where the lack of belongings testifies to a life of imposed simplicity, Margaret breaks down in tears as she describes a 13-year nightmare.
Once married, employed and insured, her life fell apart when she lost her husband and her job. At one point, she found herself homeless, living in a shelter.
Suffering from a non-malignant tumour - a notorious "pre-existing condition" - she could no longer purchase insurance.
But as her health deteriorated, she became a regular visitor to the emergency room of a local hospital.
"Every time I went to the hospital, I thought I was going to die," she says, weeping.
"I would call my son and tell him I was not going to see him again."
Caught in a downward spiral of worsening health and mounting economic hardship, Ms Torres was at her wits' end, until last week.
"I'm really excited about the healthcare reform bill," she says, her face lighting up.
"I can see myself getting insurance coverage, going back to work and being
a productive individual again."
Texas has the dubious distinction of being home to the highest number of uninsured people in the country: 25%, compared with a national average of 15%.
And Harris County - Houston and the surrounding area - has among the worst rates in the state.
Many of the uninsured depend on a network of heavily subsidised hospitals and clinics. Some 60% of the patients arriving at the El Franco Lee health centre, in Houston's western fringes, have no insurance.
On the day I visit the waiting room, President Obama is on the television, hailing passage of the bill in Washington. The patients are watching.
"How will it affect me? I'm not sure," says Rhonda. "I don't think it can get much worse, because the 'haves' have and the 'don't' don't. I mean that's just the way it is."
"Whether it's going to be positive or negative, we don't know yet," says Philip. "That's a chance that a lot of people are willing to take, just to get better attention."
The president's bill contains an ambitious pledge to extend coverage to 32 million uninsured Americans.
"It's a big moment because we do need change," says senior hospital administrator Dr Robert Trenschel.
President Obama praised lawmakers for passing the landmark bill
But, like many healthcare professionals, he does have his concerns about the impact on his services as reform is rolled out over the coming years.
"We have about 1.2 million people that are uninsured," he says of the Houston area. "If all those people became insured immediately, I don't know that the community would have the resources to treat everyone."
Dr Trenschel also notes that many doctors may choose not to take certain types of insurance, as already happens.
"Does health insurance always translate into access to healthcare?" he says. "That remains to be seen."
What also remains to be seen is the political fall-out from a protracted, bitter reform debate.
Opponents of the bill say it will be bloody.
Many conservatives oppose the Obama administration's reforms
"We'll be voting people out, even those who may have voted against the bill," says local organiser Toby Marie Walker, at the end of an animated meeting of conservative Tea Party activists in Waco, several hours' drive north-west of Houston.
It's a warning to Democrat Congressman Chet Edwards, who was among the 34 from his party who opposed the bill and whose 17th Congressional District includes Waco.
"If they don't have a really good record of being fiscally responsible, and following the constitution, nobody's safe," says Ms Walker, who says the new bill has energised the Tea Party movement.
"It poured Miracle-Gro on it and put a steroid in it," she tells her group.
The evening is peppered with expressions of outrage as members rail against what they regard as a monstrous piece of federal over-reach.
They worry about their pocket books. And their freedom.
One group member calls the new bill "a rancid cauldron".
Another receives a vigorous round of applause as she condemns the politicians responsible for what she calls "a disrespectful piece of mess to the people that elected them".