House Speaker Nancy Pelosi (D-CA) signs the Education, Jobs and Medicaid Assistance Act at the U.S. Capitol,  August 10, 2010. Alex Wong/Getty Images North America hide caption

itoggle caption Alex Wong/Getty Images North America

A pickup truck carries a sign in support of Proposition C outside a rally in St. Charles, Mo., last week for a ballot measure to block the new federal health insurance law. Jeff Roberson/AP hide caption

itoggle caption Jeff Roberson/AP