For many Long Islanders, watching the historic vote on the largest social program since 1965 - when Medicare was passed - generated mixed feelings.
The yearlong process of often rancorous debate left many of them frustrated and exhausted. No one interviewed said the legislation was perfect. Some thought it would create more problems. Yet many also embraced it as a landmark that they said could begin the process of real change.
Here's a look at how some Long Islanders viewed it:
Obstetrician-gynecologist Dr. Stuart Lustberg, 52, is on call seven days a week, often working 14-hour days at his Huntington office. He also moonlights at Huntington Hospital for a regular 24-hour shift to help pay his $175,000 malpractice insurance.
Lustberg said he supports key parts of the legislation: giving everyone access to health insurance and prohibiting denial of insurance because of pre-existing conditions. But he said because the legislation doesn't tackle the impact of malpractice insurance costs and "massively" expands benefits, he worries it will end up costing much more than its $940-billion price tag. "It's frankly very scary," he said.
Doris Cotto, 70, of Westbury, said she has good health insurance, provided after her retirement about a decade ago as a housing manager for the City of New York. But she said she is still surprised by the number of copays and small medical bills she has to pay.
Nevertheless, she said she would pay a little more if it meant everyone has health insurance. That's why she is gratified the legislation has passed. "I think everyone needs it," she said. And, she said, it may mean health care costs will come under some control. "I think it will slow things down," she said.
The small-business owner
Marilyn Schulman, 65, owner of Bay Shore Lighting and Willy Nilly Trading in Bay Shore, pays health insurance for seven employees. The cost, she said, "keeps going up exponentially." But, she said, her interest in the legislation has less to do with her business and more to do with the fact the United States is the only major country without universal health care.
She believes the legislation should require businesses, like hers, with fewer than 50 employees to provide some insurance or pay a fine - as it does for those with 50 or more workers. "I think we should spread the burden somewhat," she said. Nonetheless, she said, she is "ecstatic" the House has passed the bill.
Michael Hushin, 41, runs Lakeland Pharmacy in Ronkonkoma. Since it opened in 1984, he said, the number of independent pharmacies has dwindled as profit margins have grown smaller.
He said he is not clear on how this legislation will affect his business because the more than 1,000-page bill is so "voluminous" few Americans know what's in it. "And that's what scares me," he said. He said he would trust the legislation more if it had been bipartisan.
"I think it's getting thrust down our throats and it's going to cost everybody a lot of money," he said. "The only certain winners are the health insurance companies."
Elena Melendy, 41, of Woodmere, a freelance Web consultant, said she pays more for her health insurance than she does on her rent. She's hopeful - but not sure - the new legislation will mean lower premiums.
She called the long political process and final legislation "not ideal." Nonetheless, she said, she was happy something was finally passed. "I think it's a historic moment and achievement, and I'm relieved there is movement forward," she said.
The hospital executive
Nassau University Medical Center serves the largest number of uninsured in Nassau County, said its chief executive, Arthur Gianelli, 41. Covering an additional 32 million Americans who are now uninsured is a "monumental achievement," he said, which "shows we can do big things governmentally."
But, Gianelli said, the most significant part of the legislation is that it begins the process of transforming the way health care is delivered by putting more emphasis on controlling costs and improving quality. "That," he said, "will make or break us in the future."
The health insurance expert
Fred J. Barba, 64, of Huntington, is president of the Long Island Association Health Alliance, a health insurance exchange. He said he opposes the legislation in part because of the cost. "If you add to the budget deficit, what burden are we passing on to the next generation here?" he asked.
And he said he was disappointed because it focuses more on health insurers than on the cost and quality of health care. "This is not health care reform; it's health insurance reform," Barba said.
With Jennifer Barrios