What some are already calling the most important piece of social legislation in 40 years, Congress passed a transformative health care bill late Sunday night with a vote of 219-212. The bill needed 216 votes to pass, or fail, and was passed successfully without a single vote from House Republicans, and with 34 Democrats also voting against.

A companion package making a series of changes sought by House Democrats to the larger bill, which already passed the Senate, was also approved by a vote of 220-211. Democrats say the bill will extend coverage to 32 million uninsured Americans, reduce deficits and ban insurance company practices such as denying coverage to people with pre-existing medical conditions.

“Tonight marks the end of a very long journey,” Rep. Charlie Wilson (D-Ohio) said. “I voted for the Senate version of health care reform and for the reconciliation changes because together the bills are fiscally conservative, pro-life, good for my district and good for our economy.”

Wilson said there are 40,000 uninsured residents in Ohio’s 6th District, which includes parts of Scioto County.

The fix-it bill will now go to the Senate, where debate is expected to begin as early as today. Senate Democrats hope to approve it unchanged and send it directly to Obama, though Republicans intend to attempt parliamentary objections that could change the bill and require it to go back to the House.

“I am extremely disappointed by the health care reform bills that passed the House tonight. The American people wanted reform that lowers premiums and makes health care more affordable. They got a bill that will actually increase their premiums, increase their taxes, and increase the national debt. They deserve better,” Rep. Jean Schmidt (R-Ohio) said, after voting against the bill Sunday.

The nonpartisan Congressional Budget Office, however, said the bill will cut deficits by an estimated $138 billion over a decade. For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.

Included in the bill are measures that will bring the insurance industry, which spent millions on advertising trying to block the bill, under new federal regulation.

“The (Independent Insurance Agents and Brokers of America) is greatly disappointed that after months of negotiations, hearings, debates and votes in multiple Senate and House committees we seem to be back on square one: a bill that does little to stem the skyrocketing cost of health care and will be financed on the backs of small business during one of the most delicate financial periods in American history,” said IIABA president and CEO, Robert Rusbuldt.

The bill also has been opposed by the U.S. Chamber of Commerce, Veterans of Foreign Wars and the National Abortion Rights Action League — though a last-minute deal with a critical group of anti-abortion lawmakers Sunday afternoon sealed Democrats’ victory.

The leader of the anti-abortion bloc, Rep. Bart Stupak (D-Mich.), didn’t get to add stricter anti-abortion language to the underlying bill, but was satisfied by an executive order signed by Obama affirming current law and provisions in the legislation that ban federal funding for abortions except in cases of rape, incest or danger to the life of the mother. Republican abortion foes said Obama’s proposed order was insufficient, and when Stupak sought to counter them, a shout of “baby killer” was heard coming from the Republican side of the chamber.

Randy Arnett, president and CEO of Southern Ohio Medical Center, in Portsmouth, said it’s too soon to know whether or not this bill will be good for America.

“If it stays exactly the way it is, with 32 million Americans getting some kind of coverage, that’s obviously a good thing for those people. What we don’t know is how they’re going to be able to hold down the cost of premiums for insurance people who are healthy to make that happen,” Arnett said.

He said SOMC already provides about $27 million worth of free medical care each year for uninsured and under-instured patients, and said the bill would provide for some recovery of those costs — but not all.

“We expect the emergency room and urgent care centers to get a lot more busy than they ever have been. We think that will be an impact of this when people start getting that kind of stuff,” Arnett said. “I’m not sure about physicians. I don’t know their stance yet, but they’re likely not to take a lot more of these patients with the government payer because they also get less than money than what it costs them to deliver the care. So they’re not going to be eager to open the doors to lose money.”

In regards to physicians’ opinions, the bill has been endorsed by the American College of Physicians, the American Academy of Family Physicians, the American Hospital Association, the Federation of American Hospitals, The American Nurses Association, and the American Medical Association. The bill also is supported by the National Consumers League, the Catholic Health Association, the National Farmers Union, and United Steelworkers of America.

“After a thorough analysis of the reform package, we believe this legislation brings us so much closer to helping millions of older Americans get quality, affordable health care,” Bonnie Cramer, Board Chair for the AARP. “The legislative package cracks down on insurance company abuses and protects and strengthens guaranteed benefits in Medicare, the program millions of our members depend on and in which millions more will soon enroll. It closes the dreaded Medicare Part D ‘doughnut hole,’ a gap in prescription drug coverage that is life-threatening for many. The package stops insurance companies from pricing people out of coverage because they have an existing health problem or arbitrarily limiting the amount of care someone can receive. It also limits insurance companies’ ability to charge higher premiums based solely on age. And it improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today’s seniors and future generations.”

The health care bill now goes to President Barack Obama for his signature, which is expected to happen today.

RYAN SCOTT OTTNEY can be reached at (740) 353-3101, ext. 235, or e-mail rottney@heartlandpublications.com. The ASSOCIATED PRESS contributed to this article.