There hasn't been an issue before Congress and the American people in the past decade more important, more complex, more divisive — or that's generated more suspicion and less understanding — than healthcare reform. But, the House approved major reform legislation late Saturday evening, and the Senate will take it up soon. What was considered impossible may very well happen before the end of this year.

Something has to change and change very soon. The health care system we have is simply not sustainable. It costs too much for families. It costs too much for businesses. And, it leaves too many people out.

Since 2000, the average cost of a family premium has more than doubled. Health care premiums have grown three times faster than wages. Workers today are paying twice as much for health insurance as 10 years ago. Two out of three personal bankruptcies are due to medical bills.

Every week, 100 Hawai'i families lose their health insurance — that's 420 families a month, 5,050 a year. Today, 140,000 people in Hawai'i do not have health insurance. We have one of the highest levels of health insurance coverage in the country, yet we've had an 18-percent increase in people without health insurance in the past two years.

I voted for health care reform because it will make health care more affordable and more accessible for Hawai'i families. It provides tax credits to help as many as 116,000 Hawai'i families pay for health care insurance, families who can't afford it now.

Medicare services are improved for 105,000 Hawai'i seniors. It closes the prescription drug "donut hole" that forces 11,900 people here to pay more than they should for medicine.

It also ensures that 3,800 people in Hawai'i can't be denied health insurance because of pre-existing medical conditions. And it makes coverage more affordable for 15,000 of our small businesses. In fact, as many as 13,200 of them will be eligible for tax credits to help reduce costs.

It will help an estimated 500 Hawai'i families avoid bankruptcy every year from crushing medical costs.

It reduces the $69 million we pay every year for uncompensated medical care. Today, government covers about 75 percent of it, and Hawai'i families pay an additional $700 a year in health insurance premiums.

If you get your health care through your job, effective Jan. 1, 2010, the Healthcare Reform Plan would improve the coverage by:

• Limiting exclusions for pre-existing conditions;

• Prohibiting health insurance companies from cancelling coverage except in cases of fraud (effective July 1, 2010).

• Requiring health insurers to allow individuals up to age 27 to remain on their parents' health insurance.

• Prohibiting health insurers from imposing lifetime limits on benefits.

• Prohibiting employers from reducing retiree health benefits below what was offered at the time of their retirement unless reductions are also made to active workers' health benefits (effective on date of enactment).

• Prohibiting insurers from limiting or denying coverage based on injuries stemming from domestic violence.

• Requiring plans to pay for reconstructive surgery for children with deformities.

We also made sure that this federal plan did not supersede Hawai'i's Prepaid Health Care Act, which requires employers to offer health coverage. We've been ahead of the rest of the country since 1974 and we insisted on protecting that.

The legislation is not perfect, nor will it be the final word on health care. But it is a momentous step. The need for health care reform has been talked about since the 1950s, but proponents have never been able to overcome special interests that make so much money under the present system and want to keep things just the way they are.

They've had things their way for a long time. It's your turn.