Key to passing the bill was the approval of an amendment by Democrat Rep. Bart Stupak to prohibit the use of federal funds to pay for abortion, including barring abortion coverage from insurance plans which consumers purchase on their own using government subsidies. The USCCB and other pro-life organizations had threatened to oppose any final bill that did not include such provisions.

The final bill fell short of another element pushed strongly by the church in recent weeks. It would bar people who are in the country illegally from receiving any government assistance to get health coverage. The U.S. bishops also had urged that the legislation allow all immigrants access to the health care system, regardless of legal status.

What the bill does do is expand health insurance to an estimated 30 million people who currently lack coverage, meaning an estimated 96 per cent of Americans would have access to more affordable health care.

Various news sources reported on the last-minute, behind-the-scenes negotiations among House leaders — Stupak and others who were holding firm on withholding their votes pending acceptance of his amendment — and Catholic bishops and their staff.

When Stupak’s amendment was allowed to come to the floor, it was approved by a vote of 240-194, with the support of many Republicans who did not ultimately vote for the final bill.

Only one Republican voted for the overall bill, Rep. Anh “Joseph” Cao, a Catholic and former Jesuit seminarian who was elected in December 2008 to fill a vacancy created by the resignation of Rep. William Jefferson, who was forced out of office in a bribery scandal.

In a statement, Stupak, a Catholic who has spoken many times of his often lonely role as a pro-life Democrat in Congress, focused not on his successful abortion amendment, but on the overall bill, which he called the most significant reform to government and private health insurance programs since Medicare and Medicaid were created in 1965.