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epa02087943 US Speaker of the House Nancy Pelosi (C) laughs with other members of the House Democratic Caucus as they march from the Cannon House Office Building to the House Chamber on Capitol Hill in Washington DC, USA, 21 March 2010. Speaker Pelosi carried a gavel used to pass Medicare legislation in 1965, provided by Democratic Representative John Dingell of Michigan, as the House Democratic Caucus members marched to the House Chamber for the start of a session where they will make a historic vote on on health care legislation, estimated at 940 billion USD over 10 years. Also in the picture is Democratic Representative John Lewis of Georgia (front L) and House Democratic Caucus Chairman John Larson (front R). EPA/MICHAEL REYNOLDS