He died in his sleep Tuesday at a Scranton hospital after years of health problems, including undergoing a rare double transplant. He was 68.
Casey overcame 20 years of dashed hopes to win two terms as Pennsylvania governor, in 1986 and 1990.
He pushed through a health insurance program for children, comprehensive car insurance reform, a multibillion-dollar program to rebuild water systems and additional environmental protections.
He prided himself on overseeing a frugal government with a caring touch. His low points were losing a referendum in 1989 for tax reform and approving more than $1 billion in new taxes in 1991.
A Roman Catholic, Casey suffered for his stand against abortion but he never let go of his principles. Mark Singel, his lieutenant governor, called him "one of those rare, unwavering public servants who fought for what he believed in."
During a television debate in fall 1986, he clearly stated his position and dropped 10 points in the polls.
In 1992, Casey embarked on a campaign to pull the Democratic Party away from its emphatic stance favoring abortion rights. He repeatedly questioned Bill Clinton's viability as a presidential candidate and argued strongly to the platform committee that the party was shunning an important part of its coalition.
Clinton's forces denied Casey a chance to speak at the Democratic National Convention that year, and, in a deeply felt slap, allowed a Pennsylvania Republican who supported abortion rights a forum to speak on the issue.
In 1996, he again was denied the opportunity to speak at the Democratic National Convention. He borrowed a room across town and called a news conference instead.
"If you can pass lightly over wrongs done to your neighbor, if you can shrug off the suffering of others especially children then you are miscast for any position of public responsibility," Casey, a father of eight, wrote in the book Fighting for Life after he left office. "You should return to private pursuits where less is expected of you. You are in the wrong business."
Casey was born in New York City on Jan. 9, 1932, and grew up in Scranton. His public career began in 1962, when he was elected to the state Senate. He served as auditor general from 1969 to 1977, making his political reputation as a watchdog for taxpayers.
Casey's party nominated him for governor in 1966 and 1970 but he lost both times. When he entered the crowded gubernatorial primary again in 1978, he thought his high profile would mean victory, but he lost out to Pittsburgh Mayor Peter Flaherty.
In the 1986 primary, Casey had just one opponent, Edward G. Rendell, who was later Philadelphia's mayor and is now general chairman of the Democratic National Committee. Case won by 75,000 votes in a campaign marked by biting negative ads.
But during his tenure, health problems set in. In 1991, Casey announced he was suffering from a genetic condition called familial amyloidosis, which causes proteins to invade the heart and other vital organs. He underwent a rare heart-liver transplant in 1993.
In 1997, Casey was diagnosed with prostate cancer and underwent radiation treatments. He had been in and out of the hospital several times over the past year, and died of a severe infection.
Casey is survived by his wife, the former Ellen Harding; six children, including Auditor General Robert P. Casey Jr.; and a brother.