he's training for his next adventure, a walk across the grand canyon. >> ill like to see that. >> that would be cool. on our broadcast tonight, the history making vote on health care. >> the bill is passed. >> this is what change looks like. >> tonight we look at what changes and when. why the republicans say the fight isn't over and why the debate ended up being so nasty. also tonight, on a mission. two american presidents on the ground in haiti. we're there as well to check on progress ten weeks now after the quake. and making a difference for parents serving their country and the children who miss them back home. "nightly news" begins now. captions paid for by nbc-universal television

captions paid for by nbc-universal television good evening. it is as close to good evening. it is as close to universal health care that america will likelyver come. in size and scope it is being compared to medicare and social security and tomorrow health care reform will be signed into law by the president. in fact, our cameras captured the scene when the bill was delivered. in that box from capitol hill to the west wing of the white house. barack obama staked his presidency on this and in the end not one republican voted for it. not even all of his fellow democrats. some republicans say they will not forgive or forget how this happened. they will try to repeal it. they are vowing to defeat many of those yes votes at the polls in november. tonight we'll look at what happened, what it means and when at what cost and what happened in the debate to make it take such a visibly nasty turn. our team is in place.

beginning with white house correspondent savannah guthrie to start us off. good evening. >> reporter: good evening, brian. the health care fight is not quite over but democra are celebrating like it is. the bill's passage was a huge, definitive step in this process, a long and tumultuous fight over health care. the day after democrats were basking in their victory with fanfare signing the bill that will be sent to the president tomorrow. the culmination of the epic 14-month fight over health care came late in the night. >> on this vote the yeas are 220, the nays are 211. the bill is passed. >> reporter: from the roosevelt room of the white house the president was watching with staff then addressed the nation at 11:46 p.m. >> we proved that this government, a government of the people and by the people, still works for the people. >> kill the bill! kill the bill!

>> reporter: the vote capped a weekend of high drama. outse the capitol hundreds of protesters. speaker nancy pelosi and house leader staging an impromptu walk across the capitol among the throngs while inside a last-minute deal with a ban of anti-abortion democrats clinched the vote. >> i'm pleased to announce we have an agreement. >> reporter: the president promised to issue an executive order to make clear the bill will not allow federal funding for abortion. >> the gentleman's time is expired. >> mr. speaker -- >> the gentleman's time is expired. >> mr. speaker -- >> the gentleman's time is expired. >> reporter: the ten hours of house debate was at times unruly. lawmakers' final arguments high on passion. >> can you say it was done openly? with transparency and accountability? without back room deals and struck behind closed doors? hidden from e people? hell, no, you can't. >> reporter: democrats worked to

place the vote among legislative landmark, civil rights, social security, the speaker clutching the gavel used at the passage of medicare. >> and so the spirit of history and pass health care, give the american people a victory. give health care a chance. >> reporter: the president will sign the bill tomorrow then travel to iowa on thursday for a rally to sell it. and tonight the president's top political adviser david axelrod said the president was actually more excited last night than on his own election night. brian. >> savannah guthrie on this day after at the white house starting us off. thanks. kelly o'donnell has been following this bill every step of the way. she is on the hill tonight to tell us about that next step. kelly, for those who somehow thought last night's vote seemed final, those hearing about an effort to revise this, what's going on there now? >> reporter: well, senators will fight once more, brian. because the president can sign the bill. he can go out and sell it, but

that doesn't mean it's actually over. why? house democrats did a lot of rewriting on the health reforms that were just passed so the senate must approve those for them to take efft. this is called reconciliation. senate republicans have a strategy to try to strip out whole sections of the bill and they can offer dozens of amendments, even some appealing to democrats. if they succeed even once it goes back to the house for another vote. democrats will try to shut that down. so how likely is that? reconciliation has been used 22 times. 21 times it has gone back to the house for another vote. so let history be a guide. brian. >> all right. kelly o'donnell, we'll stay tuned to the action on capitol hill. all of this has provided a lot of drama, but a lot of americans woke up this morning trying to figure out how this affects them. how it will work when it comes to adults, children and family budgets and what it means for people with and without health insurance right now.

our own tom costello has been looking at those numbers all day. he is with us from our washington newsroom. tom, good evening. >> reporter: hi, brian. under the plan we will see some action withimonths, a new high-risk insurance pool for the uninsured with medical problems and a requirement that insurers must, in fact, cover preventive services and immunizations. other changes will roll out over the coming years. once the bill becomes law, democrats promise some changes will come quickly. insurers will be unable to deny coverage to children with pre-existing coverage or cancel coverage when someone gets sick. parents can keep older kids on their coverage until they are 26. the biggest changes will start in 2014 that's when medicaid insurance undergoes a huge expansion to cover the poor. families ming less than $30,000 and most americans would be required to have insurance.

families earning under 8,000 a year would get government subsidies to help offset the cost of buying insurance. meanwhile, a family of four earning $100,000 that does not have insurance would have to buy it or pay a penalty. penalties on uninsured families would be capped at $2,250. health care reform advocates say requiring insurance is key to controlling costs. >> because there are plenty of healthy uninsured people who will reduced premiums for sick uninsured americans by being forced to be part of the insurance pool. >> reporter: a family of four that has insurance will see no changes to their taxes or insurance coverage. to pay for the medicaid expansion, the wealthy will pay a lot more. individuals earning more than $200,000 or families earning more than $250,000 a year, medicare taxes are poised to go up on income above those levels

from 2.9% to 3.8%, a 30% increa. for the first time that tax will apply to investment income for the wealthy. as for businesses with 50 or more employees, in 2014 they have to pay $2,000 per employee if they don't offer insurance coverage. meanwhile, starting that year, small businesses and the self-employed could buy coverage through an insurance exchange. starting this year, seniors could get help with prescription drug costs. >> this plan and this effort builds upon the fact that the status quo is unsustainable because we have too many people falling through the cracks in our health care system. >> reporter: this bill does little to deal with skyrocketing health care costs now and a new federal regulator is supposed to be empowered to block excessive premium hikes. there are many questions about how effective that will be, brian. >> tom costello looking at the rules and numbers this day after. tom, thanks for that. now to how health care reform

will start to change health care as it's practiced every day in every city and town in this country. our own robert bazell spent the day at a hospital in columbus, ohio, in part to see what's about to change. >> reporter: today was a normal busy day at ohio state university medical center where at least one in ten patients has no health insurance. this woman gave birth to joshua alexander but she is leaving the hospital almost immediately. not what she and her doctors want because an extra day would cost almost $900, a price tag she can't afford without insurance. nurse loretta burton says new moms should stay for 48 hours. >> so they would have a longer period of time to stay for educational purposes and have their health monitored and for the baby. >> reporter: dr. stephen gabby, the hospital's ceo, looks forward to the time in four years when such problems will disappear because under the new law almost everyone will have

insurance. >> it's going to be different and it's going to be better. fortunately we are going to be able to focus on our efforts on prevention and wellness and seeing people outside of our emergency department. >> reporter: in some cases the benefits will begin much sooner. within months people with pre-existing conditions will be able to buy insurance and those to age 26 will be able to join their parents policies. karen is visiting her dad on medicare. she worries about her 22-year-old son with colitis. >> he just needs a very expensive medication. he needs to take it for the rest of his life. >> reporter: he is not taking it now? >> no, he is not. >> reporter: under the new law her son will be covered by her insurance. maurice burton is facing thousands of dollars of medical bills from a traffic accident. soon he will be on his mother's insurance. >> that is great. >> reporter: how great? many are waiting to see. but they have high hopes for a better medical system.

robert bazell, nbc news, columbus, ohio. there is much more information on this health care bill, what's in it and importantly how americans are reacting to it. it is on our website nightly.msnbc.com. starting with the town halls this summer up to the moment of the final vote last night the debate over health care has been downright ugly at times and this past weekend in washington on the normally peaceful, respectful grounds of the u.s. capitol, it got angry and it got personal. we get more tonight from nbc's andrea mitchell in washington. >> reporter: as the vote neared a rising crescendo of protestors outside -- >> kill the bill. kill the bill. >> reporter: echoed inside. on the house floor as anti-abortion democrat bart stupak defended his deal with the president faced shouts of baby killer. >> baby killer. >> reporter: today the shouter, texas republican randy

neugebauer fessed up, by claims he was maligning the bill not his fellow congressman. reporters in the chamber didn't hear it that way. last march neugebauer co-sponsored a birther bill, demanding birth certificates for presidential candidates, a backhanded slap at president obama. all weekend protesters vented, shouts epitaphs as barney frank, who is openly gay. they spat at congressman emanuel cleaver, used the "n" word against civil rights icon john lewis who was beaten and bloodied at the selma march. 45 years ago. >> they heard those words being used. when you looked at some of the signs that were painted out there, putting a hitler-like mustache on president obama and other things that carried double meanings. >> reporter: some republican members egged them on waving signs from a balcony. >> it sounded like it was very much orchestrated. then i look up and see nine or ten of my colleagues and literally you would thought they were at a football game or

something. >> reporter: it was a first say veteran congress watchers. >> i could hear the protesters outside chanting kill the bill, kill the bill. nancy, nancy, kill the bill. while they were voting inside. i don't think i have heard anything like that. >> reporter: it hasn't stopped. political threats today against democrats, an assassination threat against the president on twitter. the secret service is investigating and this on radio. >> we need to defeat these bastards. we need to wipe them out. >> reporter: angry words and threats once confined to the streets now seeping into the halls of congress. andrea mitchell, nbc news, washington. ripples from a political scandal last year. a.c.o.r.n., the country's largest community organizing group announced it is folding because of a lack of money. two conservative activists, you may recall, used a hidden camera to tape a.c.o.r.n. workers giving advice about avoiding

taxes to a woman who was dressed as a prostitute. that led coness to pull the group's federal funding and private donations soon followed and dried up. we'll move on to the day's other news when we come back, including two american presidents in haiti and what they found during their trip. and later, when daddy can read a bedtime story to the kids even though he is on a ship far from home. making a difference for a lot of american military families. compacted, drained of nutrients. it'll hold your plants but it'll also hold 'em back. the solution: miracle-gro garden soil. the perfect mix of rich, organic ingredients, and miracle-gro plant food. just mix it in. and turn bad soil into great soil. helps plants grow twice as big. instead of holding 'em back, they'll leap ahead. miracle-gro garden soil. and moisture control garden soil.

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we're back. we have an update on the continuing crisis in haiti devastated by that massive earthquake ten weeks ago tomorrow. today two former u.s. presidents visited there to check in on the relief effort. our chief medical editor dr. nancy snyderman is there. >> reporter: the two former presidents came for a firsthand look. but one of the first things they saw were protesters outside the presidential palace who were clearly frustrated with the pace

of recovery. it was president george bush's first trip ever to haiti. he said he and president clinton are in it for the long haul. >> our msion is to help fill the gaps of human needs. >> reporter: so far their fund-raising efforts have added up to $37 million. >> our fund was established to do what we could to help in the short run, but to concentrate on haiti's long-term economic development. >> reporter: two months afte the earthquake these once empty streets are starting to show some life again but the country is still hurting and the real road to economic recovery is going to be long and hard. the president saw that when they visited the tent city across the street from the presidential palace, now home to 60,000 people. this had been one of the most beautiful parks in the city.

we have seen the haitian people over and over again talk about hope. >> yeah. >> reporter: deep sense of national pride and hope. do you have the same? >> yeah. i believe in humanity. i lieve there is no circumstance that will wipe out hope. the question is what is the government going to do and the world coming together to make that a reality. >> reporter: the two presidents met with haitian president preval as well. on the agenda, trying to make sure all the aid efforts are coordinated with foreign investments to get people back to work. >> i have been coming here for 35 years. th country has the best chance it has ever had. >> reporter: a chance and a long-term commitment that these two former presidents won't forget haiti. dr. nancy snyderman, nbc news, port-au-prince. when we come back, fire and ice and a warning about what might happen next. ... i make my efforts count... so i switched to the freestyle promise® program...

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mourning two of its giants including stewart udall who had been the last surviving member of president john f. kennedy's original cabinet until his death on saturday. as interior secretary for jfk and lbj, he created four national parks, six national monuments, even more recreation and wildlife areas and historic sites. he even had a hand in saving carnegie hall. the arizona native gunner in world war ii, was the senior member of the udall dynasty in this country. he was 90 years old. liz carpenter has died. she was 89. lbj said once of his fellow texan "liz would charge hell with a bucket of water." she was a trail blazing journalist hired to work for lyndon johnson. she famously wrote the 58 word speech johnson gave upon arriving back in washington after jfk's assassination in dallas.

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if avodart is right for you. we're back with our "making a difference" report tonight. if you've raised little ones you know there is no substitute for reading a book before they drift off at night. there is something that comes close. for those parents who can't be close to their children because they are serving their country overseas. nbc's roger o'neal has our report from norfolk, virginia. >> reporter: daddy's still not home. >> what is it?

>> package. >> from who? >> dada. >> reporter: but the next best thing just came in the mail. >> there's our dvd. >> reporter: 5-year-old sadie and 2-year-old charlotte are too young to understand why their navy father is in some far away place called afghanistan. >> i'm back with a couple of books for you. >> reporter: but they sure like to see him on tv and listen as he reads them funny new books. >> sunflowers and a vase. >> sunflowers and a vase. >> that whole basket is what he sent. >> reporter: the girl's mom says it soothes the children. >> they call them the dada videos. i can see the light in their eyes and the joy in their faces when they get to spend time with him. >> reporter: staying united through reading is a california nonprofit started 21 years ago. on military ses and navy ships around the globe this is the aircraft carrier "uss harry truman" united through reading rooms are popular places. you can almost hear dr. seuss echoing off the walls of the ship.

the books, all of the dvds are free. with so many deployed it is a struggle to keep up. last year almost 74,000 recordings were made. >> tell dad i love you. >> i love you. >> reporter: while the revolution of new technology like skype is changing the way families stay connected. reading to children is considered irreplaceable to growing. >> giraffes i like them. ask me why. >> reporter: and it turns out not just for the child. >> it provides me a sense of calmness in knowing that i can be there even in spirit, if you will. that's all i have time for. i hope you are being good girls for mama. night night. sleep tight. don't let the bed bugs bite. >> reporter: a dad and his kids united through reading. roger o'neal, nbc news, norfolk. that's our broadcast for this monday night. thank you, as always, for being here with us as we start off a new week. i'm brian williams. we hope to see you right back

here tomorrow evening. good night. -- captions by vitac -- www.vitac.com -- captions by vitac -- www.vitac.com