The U.S. House of Representatives' passage of the Senate health care reform bill — a measure that, in the end, might seriously challenge the financial health of many small businesses, as well as some larger ones, as well as many individual Americans — does not represent an end to the reform issue.

Even if the accompanying reconciliation bill passed by the House Sunday night survives Republican challenges in the Senate, clearing the bill's final legislative hurdle, it will take years to implement all of the massive law's provisions. And, that implementation process will require close scrutiny by lawmakers of both parties.

In addition, it's likely there eventually will be a court challenge to the bill's requirement that all citizens carry health insurance.

What impact that might have on the legislation as passed is anyone's guess.

Therefore, despite Democrats' euphoria over the bill's passage, health care reform is by no means a completed deal.

Meanwhile, the overriding issue will continue to be what the reform will do to the nation's already troubled fiscal health, and the prospects aren't encouraging.

But one of the biggest questions in the minds of Americans in the aftermath of the bill's passage should be whether, amid all of the politics, negotiations and deals that preceded Sunday night's action, the people have been told the truth — and at this point there are serious questions about how much honesty has been at the forefront.

The answer to that question is what the voters must judge prior to voting in the Nov. 2 general election. Between now and then, the voters must not put this issue on the shelf, ascribing to the notion that there is nothing more that they can do. That premise is false.

Opinions coming out of Washington suggest that it could be a generation before the health care issue again is revisited. But since everyone in this country will continue to be impacted by this reform for as long as can be envisioned, the voters have the obligation to continue to judge this purported reform whenever they go to the polls in the future.

As part of that, they must know how their own representative voted on Sunday and the reasons and justification for that vote.

At this time, it also must be acknowledged that if the American people want to place some blame for what occurred Sunday, in many cases they need only go to the nearest mirror.

When campaigning for the presidency, then-Sen. Barack Obama did not hide the fact that he was hellbent on achieving health care reform. Time and time again on the campaign trail, he repeated that such reform was one of his main goals — and he was wildly cheered as he proclaimed that strong commitment.

While that intent wasn't the only reason he was elected, the voters had the opportunity to elect Obama's opponent, Sen. John McCain, if they were opposed to a major health care overhaul — but they didn't. Perhaps many people anticipated that the Obama health care reform effort was destined to the same unsuccessful fate as the reform effort of Bill and Hillary Clinton — but that Obama's other campaign promises merited his election.

Those who might have underestimated Obama's determination had their eyes opened over the past week and on Sunday night. They can only hope now that most of the dire predictions about what's contained in the health care reform legislation can be avoided, but unfortunately many won't be.

Barring a surprise in the Senate, Sunday night's 219-212 vote began an implementation process that will encompass years. The vote also ushered in a new era of deep uncertainty as the provisions begin going into effect.

In these troubling economic times, the nation did not need the fears and concerns that lie ahead.

— J.R.K.