“We already decided health care is a right by the way we treat ERs,” Pramenko said, referring to requirements that emergency rooms offer treatment to anyone. With the bill, “We’re trying to do that in the most efficient way.”

No matter how the vote was perceived, “This is historic,” Pramenko said as the vote neared the 216 needed to pass the measure. “This is a historic event the likes of which we haven’t seen in 40 or 50 years.”

It was one that Jennifer Bailey, president of the Western Slope Conservative Alliance, had hoped to avoid.

“You spend a year pretty much doing protests and then watch them force it through,” Bailey said.

Some aspects of the bill are “nice as a whole,” but Bailey said she disagreed with stipulations that those who don’t purchase health care insurance can be fined.

“The government should not be in our personal lives at all,” Bailey said.

U.S. Rep. John Salazar, D-Colo., said the vote “marks the passing of a torch that was carried by Republicans like Teddy Roosevelt and Democrats like Bill Clinton. Now that torch lights the way for all Americans to enjoy a brighter, healthier future.”

The measure includes a mandate that individuals purchase health insurance, a provision that Club 20, the Western Slope lobbying and promotional organization, has supported for more than two years.

The process by which the measure passed Congress, however, left Club 20 Executive Director Reeves Brown fretting the measure might contain the seeds that could undermine it.

“It’s important that people believe in the process that is used to develop the product,” Brown said. “I think a lot of trust in the process has been eroded through this.”

A final vote on a companion package of changes remains to be tallied in the Senate, and Sen. Mark Udall, D-Colo., said in a prepared statement he is “looking forward to casting that last vote. I am truly proud to be a part of this historic moment — this is a tremendous achievement that will provide freedom and security for families across Colorado and throughout our nation.”

Several states already are considering or have adopted opt-out measures. Colorado voters could be asked to adopt such a provision in November under a ballot measure sought by the Golden-based Independence Institute.

“We were going to go ahead with it win or lose” in Congress, Jon Caldara of the Independence Institute said. “Now it becomes a must-win situation.”

Pramenko said much of the debate about health care centered on communities such as Grand Junction, which provides health care through a network of nonprofit organizations, from two hospitals to an insurance carrier, Rocky Mountain Health Plans, to an independent physicians association and several other participants.

Several issues remain to be worked out, not the least of them ways of holding down medical costs overall, Brown said.

“We’re going to have to make hard choices,” Pramenko said in agreement. “Doctors have to realize that. There will be a limit to what government can do and pay for.”

Cost containment might call for what some would term “rationing,” Pramenko said.

“I use the term ‘comparative effectiveness,’ ” Pramenko said, using good science to determine the best treatments.

Whatever thorny issues that remain, will be best handled by communities dealing with ways to provide high quality at the least-possible cost, Rocky Mountain Health Plans President Steve ErkenBrack said.