The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act represent the most sweeping overhaul of America's health care system since President Harry Truman enrolled as Medicare's first participant in July 1965.

This sweeping reform changes the paradigm. Americans will no longer struggle to see a health care professional while big insurance companies raise premiums and executives reap multimillion-dollar bonuses. They will not be denied health insurance for having a pre-existing medical condition. More children will have basic health insurance, and seniors will not have to choose between food and filling prescriptions.

The bill is not perfect. It can be improved, and we have no doubt that it will be over time, no different than the many changes and improvements over the past 45 years since Medicare was signed into law.

Hawai'i is already home to the nation's most comprehensive and effective health care plan, and as such, this measure leaves intact the Hawai'i Prepaid Health Care Act of 1974, which ensures that virtually every employee working more than 20 hours a week receives health insurance from their employer.

Here's how Hawai'i benefits from the new law:

• As many as 10,300 uninsured Hawai'i residents previously excluded by pre-existing conditions will immediately be able to obtain coverage.

• 128,350 young adults in Hawai'i will be able to remain on their parents' policies until age 26, seven years longer than previously allowed.

• About 34,300 Hawai'i seniors will receive $250 rebate checks to fill the gap in their Medicare Part D prescription drug benefits; the coverage gap will be closed completely by 2020.

• Approximately 93,000 Medicare beneficiaries in Hawai'i will receive a free, annual wellness visit and no cost-sharing for prevention services.

• About 14,000 small businesses in Hawai'i will be eligible for tax credits for a percentage of their contribution to their employees' health insurance.

• Lifetime limits imposed on individuals by insurance companies will be no more.

• The Native Hawaiian Health Care Act is continued through 2019, providing an average of $15 million a year for Native Hawaiian health care centers on all major islands.

• Hawai'i hospitals will receive Disproportionate Share Hospital payments — an additional $100 million in federal resources through 2019 — for treating the uninsured and Medicaid beneficiaries.

• Additional investments will be made in the 23 federal community health centers that serve residents across the state, from Wai'anae to Hāmākua.

This reform is decades overdue and we are proud to stand in support. There are times when we must step forward with strength of conviction to take a measured risk, rather than be content to criticize and condemn without a reasonable alternative. "No" was not an option, and neither was "Let's go back to the drawing board and start the discussion all over again."

Too many would continue to have been hurt irreparably, particularly our children and grandchildren, and hardworking everyday families.

Forty-five years ago, the Medicare law was enacted amidst great controversy after a fiery and protracted debate, very similar to what we are experiencing today. We would like to hope that 45 years from now, the Patient Protection and Affordable Care Act will likewise be supported by a majority of Americans, as Medicare is today. Because with good health come more stable families, more thriving communities and a more robust nation, this is one of the greatest gifts we can give — peace of mind and hope.

Daniel K. Inouye and Daniel K. Akaka are Democrats who represent Hawai'i in the U.S. Senate. They wrote this commentary for The Advertiser.