WASHINGTON — Summoned to success by President Barack Obama, the Democratic-controlled Congress approved historic legislation Sunday night extending health care to tens of millions of uninsured Americans and cracking down on insurance company abuses, a climactic chapter in the century-long quest for near universal coverage.

Widely viewed as dead two months ago, the Senate-passed bill cleared the House on a 219-212 vote. Republicans were unanimous in opposition, joined by 34 dissident Democrats, including Utah's Rep. Jim Matheson.

Matheson has said the landmark changes are too much too soon and can't be reconciled financially without a lot of fiddling with the numbers and setting aside common sense.

The bill's opponents are already pronouncing today as a kind of second day that will live in infamy — the day the federal government took over health care.

"I am proud to say that I was one of the 212 members of Congress who opposed the Democrat's freedom-robbing health care bill," said Rep. Rob Bishop, R-Utah. "Poor process produces a poor product and this trillion dollar tragedy is about as bad as they come. From the very start, this bill was on course to be one of the most historic examples of why we must restore a balance of power in Washington."

Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and dozens of aides. When the long sought 216th vote came in — the magic number needed for passage — the room burst into applause and an exultant president exchanged a high-five with his chief of staff, Rahm Emanuel.

"This is what change looks like," Obama said a few moments later in televised remarks that stirred memories of his 2008 campaign promise of "change we can believe in."

"We proved that we are still a people capable of doing big things," he said. "We proved that this government — a government of the people and by the people — still works for the people."

A second, smaller measure — making changes in the first — cleared the House shortly before midnight and was sent to the Senate, where Democratic leaders said they had the votes necessary to pass it quickly. That vote was 220-211.

Far beyond the political ramifications — a concern the president repeatedly insisted he paid no mind — were the sweeping changes the bill held in store for nearly every American, insured or not, as well as the insurance industry and health care providers such as hospitals, nursing homes and medical device manufacturers.

The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade. If realized, the expansion of coverage would include 95 percent of all eligible individuals under age 65.

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.

At least one Utah lawmaker swore an oath on the floor of the Utah House that he and every freedom- and liberty-loving American would prefer death over government getting its hands on yet another American standard of excellence worldwide — the health care system.

Other opponents of the measure say the 2,700-page monstrosity is too big to work. They regard it as a set of reforms that will slowly but surely destroy "the greatest health care system in the world" and take away people's freedoms.

Proponents said it has to be big enough to set the needed foundation for the myriad changes necessary for true reform.

"This is an outright confiscation of health care reform and how we're trying very diligently in Utah to do," said state House Speak Dave Clark, R-Santa Clara and chief architect of Utah's reform effort. "This is the 'our way, one size fits all' decision that does everything but help fix a system that is clearly broken."

Fixing it should remain up close and with the states, which have taken strong positions against the tactics more than the content of the proposals, although they (the proposals) leave a lot to be desired, Clark said.

"(Washington) talks about working together and partnering with states," Clark said. "Most of the changes are years away, this does nothing about trying to curb the cost of care, and the numbers (from the Congressional Budget Office that shows savings overall in the next few years) are government accounting at its worst."

And starting today, we'll all begin paying for the $53 trillion in unfunded mandates in the reform that lies between now and those projected savings, Clark added.

Ellie Brownstein, a pediatrician and a member of the White Coats grass roots coalition of physicians and other medical providers said Sunday that the vote on the legislation doesn't mean things are set for reform. "It's not perfect, and the debate is hardly over and done. Just the opposite."

Instead of vilifying the process and demonizing what they've heard, those people should look at the vote as a reason to read the bill and try to understand what's going on, said Judi Hilman, executive director of the Utah Health Policy Project and proponent of the federal reform package.

"There's a lot of things I don't like about the bill; it's not perfect by any stretch," Hilman said. "The vote isn't about adopting an enormous set of complicated and government-ordered changes in the way health care works, the vote is about saying that at long last we've recognized that we need to tackle reform. It's not only right, it's historic, not a matter of your politics."

e-mail: jthalman@desnews.com

Health care reform timetable

McClatchy Newspapers

Within a year

 Provides a $250 rebate this year to Medicare prescription drug beneficiaries whose initial benefits run out.

90 days after enactment

 Provides immediate access to high-risk pools for people with no insurance because of pre-existing conditions.

Six months after enactment

 Bars insurers from denying people coverage when they get sick and from denying coverage to children with pre-existing conditions.

 Bars insurers from imposing lifetime caps on coverage.

 Requires insurers to let people stay on their parents' policies until age 26.

2011

 Requires individual and small group market plans to spend 80 percent of premium dollars on medical services. Large group plans would have to spend at least 85 percent.

2013

 Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000.

2014

 Provides subsidies for families earning up to 400 percent of poverty level, currently about $88,000 a year, to purchase health insurance.

 Requires most employers to provide coverage or face penalties.

 Requires most people to obtain coverage or face penalties.

2018

 Imposes a 40 percent excise tax on high-end insurance policies.

2019

 Expands health insurance coverage to 32 million people.

SOURCES: Speaker of the House, Congressional Budget Office, Kaiser Family Foundation