The U.S. House narrowly approved legislation Saturday to make dramatic changes to the nation’s health-care system, provide coverage to almost all Americans and address rising costs.

With all five Oklahomans in the House opposing it, the bill passed by a vote of 220 to 215.

As historic as the House vote may be, it was just the first of several huge tests the landmark legislation will have to pass as the Senate awaits its version. Then, if that version makes it out of that chamber, a final product will have to hammered out.

A number of difficult issues remain, possibly including abortion language attached to the bill before passage that supporters say would retain current law on barring the use of federal funds on abortion services.

Critics of the language charged that amendment expanded the existing ban.

President Barack Obama, who has made health-care reform one of his top domestic priorities, visited House Democrats earlier in the day and later spoke about the importance of the vote.

"This bill is change that the American people urgently need," Obama said.

He cited various groups that support the legislation such as doctors and nurses organizations, "who know firsthand what’s broken in our current system," and those representing farmers and retirees.

Obama said the bill would attack problems that cause 14,000 Americans to lose insurance daily and the crushing costs that keep small businesses from succeeding and bigger firms from competing.

"Answer the call of history," he said.

For Rep. Dan Boren, the lone Oklahoma Democrat in Congress, the bill caused him too many concerns, and he broke with his party and voted against it.

Boren said his top issues with the House bill were tax increases, employer mandates and the so-called public option.

Boren said the public option is a "single-payer system in sheep’s clothing."

"It is in companies’ best interest to allow people to go the public option," he said, predicting it would be the cheaper way to go.

Rep. John Sullivan, R-Okla., described the bill as a "recipe for disaster."

Sullivan also singled out the taxes on small businesses and what he termed the bill’s trillion-dollar cost.

He agreed the bill is a pathway to a single-payer system, which would lead to a government takeover of the nation’s health-care system.

Oklahoma Republican Reps. Frank Lucas, Tom Cole and Mary Fallin have similar concerns.

Lucas said the legislation was another step toward an intrusive and domineering federal government.

He said the massive effort represented by the House bill should have been broken up into a number of different bills.

Cole and Fallin focused on the impact the bill could have on Oklahoma.

"The Oklahomans I represent oppose this bill because they know what it does and what it does not do," Cole said.

"They understand that this bill will force state governments to cut services and raise taxes, and it will put government bureaucrats rather than health-care professionals in charge of their health-care system."

Citing figures from the Oklahoma Health Care Authority, Fallin said the bill could add more than $120 million in implementation costs.

Fallin said the House bill would seize control of the health-care industry, put it in the hands of the federal government, introduce job-killing taxes on individuals and small businesses, and accelerate deficit spending and the accumulation of national debt.

House Speaker Nancy Pelosi, D-Calif., described the vote as a historic moment for the nation and American families.

"For generations, the American people have called for affordable, quality health care for their families," Pelosi said. "Today the call will be answered."

If passed, Pelosi said the legislation would work for seniors by closing the so-called donut hole in their prescription drug coverage and making Medicare stronger, for young people by allowing them to remain on their parents’ policies until they turn 27 years old and small businesses by giving them access to affordable group rates.

Democratic supporters of the bill did not get everything they wanted.

Rep. Jerrold Nadler, D-N.Y., said he would have preferred a single-payer system because it would have been the most effective and least costly way to implement a health-delivery system.

According to figures provided by a state agency, 14 percent about 500,000 of the state’s 3.5 million residents are uninsured.