The Idaho House delivered Gov. Butch Otter the most significant legislative victory of his six years in office Wednesday, passing his bill establishing a state-run health insurance exchange.

The 41-29 vote on House Bill 248 came after a two-year effort and seven hours of debate, and over fierce objections from the GOP's tea party and anti-abortion wings. Forty-six lawmakers spoke.

The bill now moves to the Senate, where another long debate might follow. But after a 23-12 vote approving the Senate version in February, passage is likely.

Critical to Otter's win was December's election of House Speaker Scott Bedke, R-Oakley, which changed the balance of power in the House.

Bedke oversaw debate with a firm, respectful hand. His manner reflected his view that despite revulsion for President Barack Obama's Affordable Care Act, a state plan is superior to a federal exchange because it will save Idaho jobs, be less expensive and be more responsive to consumers.

Early last year, Otter backed away from his plan because of opposition from then-House Speaker Lawerence Denney, R-Midvale. On Wednesday, Denney debated against HB 248 and for an effort to sidetrack the bill for an anti-abortion amendment.

Denney's top ally, Majority Leader Mike Moyle, R-Star, gave an impassioned 12-minute speech that prompted applause from exchange foes in the gallery. Moyle called a state exchange "hogwash" and a fiction. He said Idahoans running it would be reduced to "sock puppets" following federal orders.

"Don't get wrapped around all those lobbyists that are taking you to dinner. Don't get wrapped around all those things you see on your computer. Just step back," Moyle said, pounding his chest with a fist. "How's it feel in here? Right there. Because if you have any doubt, you better vote no."

The floor sponsor, Health and Welfare Committee Chairman Fred Wood, R-Burley, was on his feet for about two hours, debating and fielding dozens of questions, chiefly from opponents.

"We don't have the choice to not have an exchange," Wood said over and again in various ways, reminding the House that the feds will step in if Idaho takes a pass. "This is a big-picture issue."

The abortion amendment provided the biggest threat. Moyle and Rep. Lynn Luker, R-Boise, said the governor's office rejected an amendment during a weeklong pause that Bedke ordered to allow revisions of the Senate-passed bill.

Rep. Vito Barbieri, R-Dalton Gardens, reprised a claim made in the Senate that "Plan B" and "Ella" drugs induce abortion, violating personal conscience and religious freedom.

The House's two physicians - Chairman Wood and House Minority Leader John Rusche - said the drugs are not prescribed to end pregnancy.

"There is no evidence that Plan B or Ella are abortifacients," said Rusche, D-Lewiston. "They are contraceptives."

Wood reminded the House that the 2012 Legislature passed a law invoking an opt-out provision in Obamacare that prohibits an Idaho exchange from offering abortion coverage.

Rep. Rick Youngblood, R-Nampa, one of 14 Republican freshman backing HB 248, said the amendment was unnecessary and resisted any suggestion that he is soft on abortion.

"I am offended by this amendment," he said. "I am a pro-life Republican."

The motion to sidetrack the bill for the amendment failed, 38-32.

Otter and his aides, particularly Chief of Staff David Hensley, combined patience, persistence, and public and private pressure to win votes. They enlisted a coalition of business interests, led by insurers and health care providers, who paid for all those dinners that Moyle mentioned.

Other than Otter, no one was more pivotal than Bedke, who bared his neck knowing he had a divided caucus. Among the 57 Republicans, 28 voted for the bill and 29 against. All 13 Democrats voted aye.

Had Otter lost this fight, it could have emboldened U.S. Rep. Raul Labrador's talk of a primary challenge next year. Labrador lobbied legislators against the exchange.

As a member of the Legislature in 2009, Labrador helped defeat the governor's plan to boost transportation taxes. This time, with plenty of help, Otter carried the day, significantly strengthening his prospects for a third term.

Dan Popkey: 377-6438, Twitter: @IDS_politics