In a vote of historic proportion, the U.S. House of Representatives passed the Patient Protection and Affordable Care Act, otherwise known as “health care reform”. Voting in favor were 219 Democrats and no Republicans. 34 Democrats joined the 178 Republicans in voting against the act. A list of who voted which way is available here.

The President signed the bill on Tuesday. It is now law, pending challenges in the courts by multiple states and individual congresscritters. Meanwhile, a package of changes (made by the House who did not really like the Senate bill they approved) is making its tortured way through the Senate using a “reconciliation” process normally reserved for budget issues. The purpose of using this process, once called “the nuclear option” when Republicans proposed using it when they controlled the Senate, is to bypass the usual requirement for 60 votes to kill a filibuster allowing legislation to pass by simple majority instead.

The Democrats lost their filibuster proof majority when Scott Brown was elected (on a platform of killing health care by ending the filibuster proof majority) to fill the seat in Massachusetts vacated by the death of Senator Kennedy. Hence the need to get around those pesky filibuster rules. When Republicans tried this, Democrats rightly cried foul. But now that they are in power it is apparently OK. All things are possible when one is about the people’s work in pursuit of the greater good, after all.

So, now that the health care reform package has passed, and the camel’s nose is under the tent, the question is, now what?

Polling data shows that the issue is currently wildly unpopular with the American people. Some dislike it because they perceive it as not just creeping, but galloping socialism. They look at socialized medical systems around the world, and, rightly in my opinion, perceive a general decline coming in the availability and quality of health care in the United States.

And no, it won’t be “free”.

Others are disgusted with the process by which the health care bill has come to pass. Many on the left are upset because they don’t believe the bill went far enough.

Republicans vow to continue the fight.

So now the question is, what will the American people do about it?

There are many on the right and within the Republican Party who think that the Democrats have committed political seppuku on this one. That the American people are solidly against this bill on its face, and that by forcing it down everyone’s throats, they will face a bloodbath of voter wrath come the November elections, ushering in a new era of Republican majority in one or both houses of Congress. Some conservative pundits are pretty much rubbing their hands together with glee at the prospect of running Harry Reid, Nancy Pelosi, and their ilk out of town on a political rail, and ensuring that Barack Obama goes down in history as the first one-term Democratic president since Jimmy Carter.

Perhaps. But we are a long way from the November elections. In politics, the only thing that is sure is that nothing is sure. Who would have predicted back in January last year, when President Obama took office that his approval rating and that of his party would have dropped so far so fast? The man had everything going for him. People wanted to like him. I think many still do, despite his current numbers. A lot depends on what the Democrats do next. If they lay low, concentrate on jobs creation, and don’t try to ram additional controversial legislation down the public’s throats, they may come out ok in the November elections. (Then again, they may be unable to resist the urge and pressure from segments of their base.)

That doesn’t mean they won’t lose seats; historically, the party in power does lose seats in the midterm elections. However, they have a comfortable lead in both houses, so losing a few seats does not mean losing control. Passing health care, however unpopular, does not automatically signal a Republican takeover of either or both houses in November, however much Republicans and conservatives hope it might.

First, people are still upset with the Republicans. There is little confidence among conservatives that, once back in power, Republicans will “dance with the one what brung them.” About the best that can be said for Republicans the last time around is that they overspent less than the Democrats did, grew government less than the Democrats did, and moved us toward socialism slower than the Democrats are now doing. They certainly didn’t demonstrate any drive toward smaller government and living within our means.

Republicans are depending on being “the only other game in town.” It remains to be seen if they have actually learned anything as a party. True, there have been some, such as Jim DeMint that have done an outstanding job, and seem to be truly conservative. But as a whole? I am not sure the party really gets it. The 2009 special election in New York’s 23rd congressional district, for example, seems to me to signal “business as usual”, at least for some segments of the party.

Second, despite all the rhetoric against the health care reform act, most Americans will soon perceive that the sky is not falling; at least not immediately. Was passage of the bill a mistake? Yes, I believe so. Will it ultimately lead to the destruction of our private medical system and the creation of a single-payer government system in the vein of European and Canadian style health care systems? Yes, over time I believe it will; I will go further and state that I believe that is the intent of the President and the Democrat party. But it won’t do so overnight, and that is key.

It will take time before those in the federal government actually get the regulations empowered by the bill written and in place. Until they do, nothing will change. Also, most of the bill’s provisions do not take effect immediately. Many of the taxes won’t happen until later; the boost in the Medicare payroll tax starts in 2013, as does the cap on tax-free flexible spending accounts. Most of the big provisions, such as the requirement that you purchase health insurance, the expansion of Medicaid, and mandated changes in private insurance to meet new requirements like caps on out-of-pocket costs are not scheduled to begin until 2014.

Meanwhile, as the November elections roll around, Democrats will be able to tell their constituents “see, that wasn’t as bad as the Republicans made it out to be. You still have your private insurance and you still have your doctor, just as the President promised.” Except for those who frequent tanning salons (who will see a 10% tax levied on them immediately), and maybe some other small bits and pieces (who knows what all is in the bill; it’s over 2000 pages!), most people will see no immediate increase in their tax burden due to this bill. In effect, life will go on, pretty much as it has before the bill was passed.

Yes, it is an enormous government intrusion into our lives. Yes, it is, ultimately, European style nationalized health care. Yes it is expensive, and we probably cannot afford it. At a time when the economy is doing poorly, when all our other entitlement programs are in the red and sinking fast, and when the baby-boom generation is moving from an income generator to an income sink, this is arguably not the time to add yet another massive federal entitlement to the mix. Still, it is difficult to maintain the anger over a period of months about a bill that is now over and done with, and about which there is as yet no visible sign of the predicted catastrophe.

It’s also hard to maintain outrage over a philosophical idea such as socialism, when people can’t see it immediately affecting their lives in a negative fashion, and when many actually embrace it. Let’s face it; most Americans could care less about political issues in the normal course of events. As long as they can shop, catch their favorite TV show, and down a brewski or two they are pretty content. Only when any of those activities are threatened (or there is a perception that they might be threatened) do most people sit up and take notice - after a fashion anyway.

As for the public’s disgust with Congress, well, the people have been disgusted with Congress before. It doesn’t necessarily translate into dumping incumbents. Recent polling data shows congress with only an 11% approval rating, with 64% saying they are doing a poor job. But that is up 7% from last week. One thing about polling data; it changes daily. And I have never been a big advocate of governing by the polls.

The polls show that people are upset with both sides of the aisle; Republicans and Democrats. But when push comes to shove, realistically, one has to vote for one or the other. So what does this polling data really mean, except that people really are not fond of either?

Polling shows Nancy Pelosi with only an 11% favorable and a 37 % unfavorable rating. Harry Reid weighs in at 8% favorable and 23% unfavorable. But so what? Most Americans will get to vote for neither of the two. Reid only has to worry about what Nevada voters think (and he is facing a tough fight there), while Pelosi only has to worry about voters in her very liberal district. Having just passed the health care act, she is probably sitting pretty with the voters back home, even if everyone else in America would like to toss her out of office.

Yes, it was a prime example of dirty politics, but progressives believe in that “the ends justify the means” stuff. So will that really hurt Pelosi in her district? Probably not.

The thing I find interesting in both of these cases is the number of Americans who haven’t heard enough to formulate an opinion at all; 36% in the case of Pelosi and 50% in the case of Reid. As much as these two have been in the news recently, this indicates to me that despite the rancor this bill has generated, much of America is still asleep at the switch. For a large chunk of our population, politics really doesn’t matter. Will these folks vote in the next election? Do they even know we are having an election in November?

I don’t know. There are some whose anger will carry over into November. There are some, particularly those in the tea-party movement, who are now awake, aware, and active. They will vote in November. How they will vote remains to be seen. Tea-party votes do not necessarily translate into Republican votes. I have been to several tea-party gatherings. Many of these people are upset with Republicans too.

It is important to ask why people are upset. Some are upset at the government takeover of health care. Some are upset because they don’t think the bill went far enough. Some are upset at the process itself; the pay-offs and arm twisting – the making of the sausage was very visible this time. That doesn’t mean they don’t like the bill however, and it doesn’t mean they will still be upset in November.

If the elections were today, it probably would be a bloodbath for the Democrats. But by November, who knows?

Ultimately, what the economy is doing come November will probably have the biggest influence on what Americans do once they enter the polling booth.