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Speaker Nancy Pelosi of California, holding the gavel used to pass Medicare reform, laughs as she walks toward U.S. Capitol as the House prepares to vote on health care reform Sunday, March 21, 2010. Walking with Speaker Pelosi are from left, Rep. Steny Hoyer, D-Md., Rep. John Lewis, D-Ga., and Rep. John Larson, D-Conn.

Charles Dharapak / Associated Press