With fiery oratory, name calling, and plaintive pleading that marked much of the last 13 months of healthcare debate, lawmakers finally passed historic reform legislation with a vote of 219 to 212, three votes more than they needed.
Leaders will have to figure out how the government will implement and administer the numerous provisions over the coming months. And many key mandates of the new law won't take effect for years.
But what do health leaders think of Sunday's health reform vote? Here are the thoughts of 11 leaders:
Rich Umbdenstock
President and CEO
American Hospital Association
"For years, America's hospitals have worked hard to make coverage for all a reality.
"Today, a historic and long overdue step was taken toward achieving that worthy goal. This bill, which we support, will make a real difference in lives of millions of Americans.
"Healthcare is at a tipping point and the shortcomings within our healthcare system can no longer be ignored. Today's vote will chart a new and better course for our nation's health and healthcare. Bottom line: the health reform bill may not be perfect, but it expands coverage to 32 million people, enacts significant insurance market reforms, and lays a solid foundation upon which we can continue to build."
Karen Ignagni
President and CEO
America's Health Insurance Plans
"The access expansions are a significant step forward, but this legislation will exacerbate the healthcare costs crisis facing many working families and small businesses."
Jim Conway
Senior Vice President
Institute for Healthcare Improvement
"Historically, I have been worried over whether we as a healthcare industry had the individual and collective guts to drive change with this level of complexity. What I've have seen over the last five years in Massachusetts, says 'yes' and what I have seen in the last year nationally in the collective conversations and actions of the healthcare industry says 'yes.'
"Besides, as a leadership community, we must honor those we are privileged to serve and get on with it now. Look at the amazing opportunity we have been given and we have no other option."
J. James Rohack, MD
President
American Medical Association
"Historic passage of health system reform . . . is an important step toward providing coverage to all Americans and improving our nation's health system. Every day, physicians see the devastating effect being uninsured has on the health of our patients.
"While the House-passed bill isn't perfect, we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans.
"By extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and the physicians who care for them. There are increased payments for primary care physicians caring for Medicaid patients and bonus payments for physicians in underserved areas.
"Those who have insurance will see improvements right away: lifetime caps on coverage end; children can stay on parents' policies until age 26, and insurance companies can't cancel coverage except in the case of fraud.
"We will remain actively engaged to ensure that before Congress adjourns there are additional important changes to our health system that couldn't be addressed in the reconciliation process, including repeal of the Medicare physician payment formula that threatens access to care for seniors and military families.
"Congress must also move immediately to correct problems with the Independent Payment Advisory Board. The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize healthcare delivery.
Judith Stein
Executive Director
Center for Medicare Advocacy
"[House lawmakers] had the courage to protect the interests of the 32 million Americans who lack health insurance and the 45 million Medicare beneficiaries who need added protections rather than the interests of insurance companies.
"The measure passed today provides access to health insurance for millions of Americans, provides subsidies to those with limited incomes and resources, improves access to preventive services, and limits discrimination in the offering of health insurance.
"The bill protects the integrity of the Medicare program by reducing overpayments to private Medicare plans and by promoting delivery system reforms to encourage high quality, coordinated health care. The bill further assists people with limited means by extending eligibility for Medicaid for the under 65 population."
Joseph W. Stubbs
President
American College of Physicians
"This historic measure advances long-standing ACP policies to provide all Americans with access to affordable health insurance coverage. It fills gaps in our current system by providing families and small businesses with competitive and portable private sector options to buy affordable coverage, providing subsidies when they need help, and ending egregious insurance company practices that deny patients with pre-existing conditions access to affordable coverage.
"Without reform, tens of millions of Americans stood to lose access to affordable health care and out-of-control spending would have triggered an unprecedented fiscal and budgetary crisis.
"The legislation includes some important first steps to begin to reverse a catastrophic shortage of primary care physicians, but more will need to be done to ensure that patients will have timely access to care by an internist or other primary care physician of their choice.
"We will continue to urge Congress to make improvements through subsequent legislation, including additional reforms to support the value of care provided by internists in a Patient-Centered Medical Home, to make permanent improvements in Medicare and Medicaid payments, to reduce the costs of defensive medicine, and to end the permanent cycle of Medicare (SGR) physician payment cuts.
"However, health reform is a process, and enactment of this package is an essential beginning, but not an end, of our continued effort to reform America's healthcare system consistent with ACP policies."
"The U.S. Senate should promptly enact the improvements included in the 'corrections' legislation including increasing the subsidies to making coverage affordable, providing equitable support to all states to cover the cost of expanding Medicaid, eliminating the Medicare Part D doughnut hole, and increasing Medicaid payments for primary care physicians."
Tim Size
Executive Director
Rural Wisconsin Health Cooperative
"The healthcare legislation that looks headed to the President's desk is not ideal. It couldn't be otherwise given our country's deeply held and contradictory values. But the fact that tens of millions of Americans are uninsured and most of the rest of us are just one lost job from the same dilemma, drove this train.
"A majority in the Senate, and now the House, have decided they couldn't lose another generation in pursuit of the perfect bill.
"Assuring universal coverage for the rest of America was widely believed to be right around the corner. It has been a long corner. It took us the greater part of 20 years to work through challenges caused, but not anticipated, when the Medicare Prospective Payment System began in 1983. It will take at least that long for all of us to digest this new change. From a rural perspective, here are some of the priority areas that will need our attention:
"Protecting access to local care is a high priority as we address the systemic changes this legislation will incentivize. Equally a threat to access is the soon to explode retirement of baby boomers, leading to worsening of the current mal-distribution of healthcare professionals.
"Given the history of rural health voices being underrepresented on the current Medicare Payment Advisory Commission, an even more powerful commission is potentially threatening to rural equity and will require even greater vigilance.
"Health reform's first installment was the American Recovery and Reinvestment Act and its focus on health information technology. Unfortunately, it appears that many decisions to date, by Congress and the Administration, are leading to an increase in the rural-urban digital divide."
Blair Childs
Senior vice president of Public Affairs
Premier healthcare alliance
"On behalf of 2,300 nonprofit hospitals across the country, members of the Premier healthcare alliance applaud Congress for passing important reforms that will help improve healthcare quality and reduce costs.
"While there are many initiatives our alliance members can undertake on their own to improve the quality, safety, and affordability of community healthcare, we needed this government action to fix perverse Medicare payment incentives. Delivery system reforms, such as the expansion of hospital value-based purchasing, creation of Medicare-based Accountable Care Organizations that also allow CMS to join ACOs in the private market, and national pilots to test the effectiveness of bundled payments, will go far to improve the quality and cost effectiveness of healthcare.
"Similarly, the creation of an independent comparative effectiveness research institute, establishment of a CMS Innovation Center, increased investment in the development of quality measures, and the disclosure of payments of value to physicians will increase transparency, reduce care variation, and avoid unnecessary healthcare costs.
"As a nation, we have taken a significant step to enact health reforms that will create system-wide sustainability and improve the quality of care for all Americans, and we look forward to working with the Senate to now pass the reconciliation package."
Ken Johnson
Senior Vice President
Pharmaceutical Research and Manufacturers of America (PrRMA)
"We continue to believe that comprehensive healthcare reform will benefit patients and the future of America. That's why we have been involved in this important public policy debate for more than a year and why we support action by the House to approve the Senate-passed bill along with the amendments found in the reconciliation legislation.
"The existing barriers to quality healthcare simply are not acceptable. Today's important and historic vote in the House will help to expand healthcare coverage and services to tens of millions of Americans who are uninsured and often forced to forego needed medical treatments.
"Our commitment to help pay for healthcare reform will require all of our companies to make some difficult choices moving forward—on top of already losing more than 150,000 jobs since 2007 because of the recession and other economic factors.
"But throughout this long process, we have been guided by a belief that all Americans should have access to high-quality, affordable healthcare coverage and services. This legislation, while not perfect, is a step in that direction.
"Even as we support healthcare reform legislation, we continue to have concerns about a number of issues including the overly broad powers of a non-elected Independent Payment Advisory Board (IPAB), which could enact sweeping Medicare changes without action by Congress and would not be subject to judicial or administrative review. We look forward to working with Congress to address these concerns and to identify ways to contain medical costs without creating new barriers to quality healthcare.
"Most importantly, we must also take steps in the years ahead to support critically needed innovation, ensuring future medical advancements and breakthroughs.
"Americans deserve no less. New, cutting-edge medicines have dramatically increased life expectancy rates all across our nation and allowed patients to live longer, healthier and more productive lives. We remain totally committed to seeing this progress continue, benefiting Americans for generations to come."
Thomas C. Bent, MD
President
California Association of Family Physicians
"This historic legislation will save patient lives. One of every four Californians—8.2 million people—has no health insurance. Eight people die every day in our state because they have no coverage and can't afford healthcare. Today marks the beginning of the end of such inhumane conditions.
"Family physicians, as patient advocates, are pleased with many provisions in the Senate and House bills, including those that will provide healthcare coverage to tens of millions of uninsured, improve the quality of care in America, and ban insurers from denying coverage to people with pre-existing medical conditions. This is a great first step in reforming a healthcare system in which too many people fall through the cracks and too few can afford care.
"One of the most important changes is the bills' emphasis on the patient-centered medical home, a new model of healthcare delivery. The medical home model addresses the importance of primary and preventive care in keeping patients as healthy as possible while keeping healthcare costs as low as possible. It's the future of American healthcare.
"By ensuring every patient has an ongoing relationship with a primary care physician, we can focus on prevention and chronic disease management instead of waiting until illnesses become crises."
C. Duane Dauner
President and CEO
California Hospital Association
"California's hospitals have advocated for meaningful healthcare reform for more than two decades. The legislation enacted tonight will increase coverage for an estimated 32 million Americans.
"This is a significant step forward. A major portion of the savings in the package, however, is based on future payment cuts to hospitals and other providers.
"The impact of these cuts is not yet fully understood, but it will undoubtedly worsen the already precarious financial situation hospitals face. In 2009, California hospitals had more than $8 billion in losses from the Medicare and Medi-Cal programs. During the next few years, CHA will strive to make improvements to the financial impacts of this legislation."