(Updated 2 p.m. Mon., Nov. 9) Posted 2:30 a.m. Sun., Nov. 8: Missouri's nine members of Congress split along partisan lines -- with one exception -- in Saturday's late-night vote that saw the U.S. House pass a health-care bill that includes a public option.

Three Democrats voted for the bill, and Missouri's five GOP members of the U.S. House voted against it.

The exception to the party-line split was U.S. Rep. Ike Skelton (left), D-Lexington, who voted against the largely Democratic-crafted bill. He was among 39 Democratic defectors, who were off-set slightly by one supportive Republican vote.

The final tally: 220-215. (That means every House member cast a vote, a rare occurrence.)

UPDATE: One of those "yes" votes came from U.S. Rep. Russ Carnahan, D-St. Louis, who said at a news conference Monday at Lambert Field airport that the bill's passage is evidence that "momentum is gaining'' for congressional and federal action to change the nation's health care system.

Greeted by a couple dozen supporters, Carnahan said he understood that the pressure now is on the U.S. Senate, which he said will likely craft a different health care bill -- but he emphasized that he expected the Senate approve a measure, which then will need to be meshed with the House version.

  Supporters of health care changes need to keep their eye on the broader objective, and not get enmeshed in debates on the particulars, the congressman said.

Carnahan asserted that he wasn't afraid of the political fallout over his support of the Democratic-backed bill.

"I did not vote on this bill because of an election,'' Carnahan said, adding that he supported it "because it's the right thing to do."

 The Washington Post posted online an interesting chart that pairs each legislator's vote with the amount of donations they've received from the insurance industry and the percentage of their constituents who don't have insurance.

The comparison makes for some interesting reading and bursts some assumptions. In Missouri, for example, the opponents included U.S. Rep. Todd Akin, R-Town and Country, whose district had the state's lowest percentage of uninsured (under 8 percent), and Rep. Jo Ann Emerson, R-Cape Girardeau, whose district had the highest percentage (almost 20 percent).

 Carnahan had the second-lowest percentage of uninsured residents.

The bill's most outspoken opponent, U.S. Rep. Roy Blunt, R-Springfield, had collected the most donations from insurance companies (about $2.5 million), while fellow opponent Blaine Luetkemeyer, R-St. Elizabeth, had collected the least (just under $62,000).

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Skelton said the final version of the bill was much improved, but not enough. He suggested that Congress deal with "one issue at a time'' in improving health care, instead of passing a massive overhaul.

In his statement after the vote, the congressman said:

"I am concerned about the impact the legislation could have on rural hospitals and doctors.  The proposed reductions to Medicare reimbursement could further squeeze the budgets of rural health-care providers."
 
"I also oppose the creation of a new government-run public option and continue to have serious concerns about its potential unintended consequences for Missourians who have private insurance plans they like." 

 Carnahan has been a target of conservative opponents for months because of his continued embrace of the general Democratic proposals to change the nation's health-care system, including a public option.

Carnahan was the region's first to fire off a post-vote statement.

“After years of effort, months of debate and listening to the ideas and concerns of people throughout Missouri, momentum is on the side of the American people and health-insurance reform,” Carnahan said. “Today we are one step closer to enacting health-insurance reform that controls costs, provides choice and competition, and emphasizes wellness, prevention and shared responsibility.”

“If health-care reform were easy we would have accomplished a more sensible system when President Truman was in the White House,” said Carnahan.  “For our country to dig ourselves out of the worst economic crisis since the Great Depression bold and decisive action is needed."

(His announced Republican rival, St. Louis lawyer Ed Martin, soon after issued a statement blasting Carnahan's action.)

The region's other Democrat, U.S. Rep. William Lacy Clay, also voted for the bill, as did U.S. Rep. Emanuel Cleaver, D-Kansas City.

U.S. Reps. Todd Akin (left), R-Town and Country, and Blaine Luetkemeyer, R-St. Elizabeth, voted against it, in line with their longstanding opposition.

Akin had issued a statement Friday making clear that he would not change his mind.

Among other things, he asserted that the bill amounted to "levying of billions of dollars of taxes on our small businesses, as well as the consequent losses of millions of more jobs brings the proposal for socializing health care from the realm of the irrational to the dangerously delusional."

Said Luetkemeyer, in part, in a lengthy statement after the vote:

“By forcing this mammoth overhaul on hard-working Americans, Nancy Pelosi and the liberal majority are creating a health-care system that increases taxes on small businesses, reduces benefits and choices for seniors, and piles insurmountable debt upon our children."

U.S. Rep. Roy Blunt, R-Springfield and a candidate for the U.S. Senate, also was quick to issue a statement late Saturday condemning the bill's passage:

"It’s families and patients who will suffer most under this government takeover of health care.  This bill costs more than $1 trillion, increases premium costs, puts a bureaucrat between you and your doctor, and pays for most of it with Medicare cuts and job-killing tax hikes," he said.  

"Instead, we should be focused on fixing what is broken in health care by keeping costs low through medical liability reform and improving access -– even for those with pre-existing conditions -– through small business health plans and risk pools.”

Across the river in Illinois, U.S. Rep. John Shimkus, R-Collinsville, also detailed late Saturday why he opposed the bill.

In his floor speech Shimkus asserted, "The goal of this legislation has been clear from the beginning.  To pass a public option that will serve as a gateway to single payer, government-controlled health care."
 
Shimkus contended that a government-run system would soon drive out private insurers and "will inevitably have to ration care."