WASHINGTON – The Senate passed a sweeping healthcare reform bill Thursday morning by a 60-39 margin, all but ensuring that President Barack Obama will get one of his legislative priorities written into law in early 2010.
The Senate bill must now be reconciled with the House version, which was passed earlier this fall. When those differences are resolved, a final vote of approval from Congress is all that stands in the way of the President's signature enacting the bill into law.
The House and Senate bills agree on a number of measures.
Both mandate that all Americans buy insurance or face fines, both call for subsidies for low-income families to buy insurance, and both would limit out-of-pocket expenses and prevent insurance companies from denying coverage due to pre-existing conditions.
Both bills would expand Medicaid coverage to include more poverty-level Americans and create health insurance exchanges where uninsured Americans and small companies could buy health insurance at competitive prices.
But there remain significant hurdles to passage. The bills hold several obstacles that may be difficult to resolve in conference, including the use of federal funding for abortion, a public health option and the price tag. Senate leaders have been criticized for watering down their bill to gain votes, including eliminating a public healthcare option. House leaders have said they will not compromise on issues such as the public option.
White House officials have indicated that the president hopes to have the bill on his desk before his State of the Union speech in late January, but others on Capitol Hill have speculated it will be difficult for Congress to meet that deadline.
Nonetheless, in remarks Thursday morning following the Senate vote, the President was optimistic.
"Ever since Teddy Roosevelt first called for reform in 1912, seven Presidents -- Democrats and Republicans alike -- have taken up the cause of reform," President Obama said. "Time and time again, such efforts have been blocked by special interest lobbyists who’ve perpetuated a status quo that works better for the insurance industry than it does for the American people. But with passage of reform bills in both the House and the Senate, we are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people."
More Concerns
Industry organizations are already weighing in on the likely outcome of the reconciliation.
The Medical Group Management Association praised the House bill, which was passed Nov. 7, for its provisions to simplify administration, which will call for the widespread use of healthcare IT. The $871 billion Senate bill contains measures to build U.S. healthcare on a pay-for-performance platform, but MGMA officials said that the final bill needs to ensure that medical group practices can deliver quality care in the future.
MGMA President William F. Jessee, MD, said he is concerned about the bill's provision calling for punitive penalties for physicans who fail to participate in the "largely imperfect" Physician Quality Reporting Initiative and other value-based purchasing initiatives.
The association is also concerned with the bill's provision to release Medicare data to the public without adequate protections to ensure that the information is accurate, statistically valid and verifiable by physicians prior to its release, Jessee said.
The American Medical Association released a statement from its president, J. James Rohack, M.D., who said, "While this vote closes one chapter of the legislative process, the hard work is not yet done. The AMA will stay constructively engaged throughout the House and Senate conference process to continue to improve the final bill and assure the best outcome for patients and physicians."
According to Rohack, issues that need to be resolved in the House-Senate conference committee include the scope, authority, accountability and transparency of a payment advisory board. The details of "several cost control and quality improvement initiatives also need to be refined so that they do not have unintended consequences for patients and physicians."
Blair Childs, senior vice president of Public Affairs, Premier healthcare alliance, added, "Premier continues to have serious concerns about the legislation’s hospital readmission and healthcare-acquired condition (HAC) policies. Provisions to reduce Medicare payments for HAC complications could lead to hospitals being penalized up to three times for the same infection. We are also deeply concerned that penalizing hospitals for 'excessive' 30-day readmissions rates could disadvantage vulnerable populations."
"With today’s vote, we are now incredibly close to making health insurance reform a reality in this country," President Obama said, acknowledging the tasks that remain. "Our challenge, then, is to finish the job. We can't doom another generation of Americans to soaring costs and eroding coverage and exploding deficits. Instead we need to do what we were sent here to do and improve the lives of the people we serve. For the sake of our citizens, our economy, and our future, let’s make 2010 the year we finally reform health care in the United States of America."
