By Susan Smallheer, Rutland Herald

Rep. Peter F. Welch, said Sunday that the historic health care reform bill passed by the U.S. House late Saturday night was far from perfect, but was "a solid step."

"It's historic, but this is not the perfect bill," said Welch, a Democrat, in a telephone interview from his home. "It was ferociously difficult to get this passed. It passed by an eyelash. "

Welch said the bill passed by an effective two-vote margin – if two representatives had changed their votes, the five-vote margin of success would have vanished. The final vote was 220-215.

"Health care reform has eluded us for generations," he said.

Welch said he wanted to see a stronger public option, something he said he had fought for.

"Consumers get one more solid choice and insurance companies get competition," he said.

According to Welch, the biggest concern he heard was that people can't afford health care.

"There's a lot of support of single-payer," in Vermont, he said, largely because the state is ahead of most other states debating the issue of health care reform.

The bill, the Affordable Health Care for America Act, now goes to the Senate and is expected to pass in some form, according to President Barack Obama.

The bill does include the so-called public option, which was one of the more controversial aspects of the bill.

The public health insurance option creates a voluntary insurance program that will compete with private insurance, Welch said, "adding choice and reducing costs."

A single-payer system, which was strongly supported by most of the people who contacted his office, was out of the realm of political possibility, he said.

"The votes just weren't there," said Welch, who had been one of 87 sponsors of a single-payer bill

The great accomplishment of the bill is that it extends health insurance to 37 million people currently uninsured, he said. And gone is the insurance industry's practices of denying covering to people with pre-existing conditions and dropping coverage of people who become sick

Also gone is the go-called "doughnut hole" for Medicare patients, who find themselves paying for their prescriptions after payments for their prescriptions to a certain amount. That provision affects 7,600 Vermonters

Welch said another improvement was extended coverage for young people, which allows them to remain on their parent's health insurance plans until they are 26 years old.

According to House estimates provided by Welch's office, the bill will improve employer-based coverage for 381,000 Vermonters and provide credits to help 156,000 Vermont households pay for coverage.

Welch said that several Vermont health care innovations were incorporated into the House bill, including the Blueprint for Health, the Vermont program that compensates primary care providers for managing and coordinating patient's care, as well as the accountable care organization, which grew out of research by the Dartmouth Institute for Health Policy.