With its approval of HR 3962 Saturday night, the House of Representatives cleared a major hurdle, but there are still plenty of barriers in place before health reform becomes a reality.
Attention now switches to the Senate, which will soon debate its own health reform legislation.
Many Democratic leaders praised the House bill, though many liberals remain disappointed in the legislation. Republicans, meanwhile, largely panned the bill that they see as an avenue toward government-run health insurance without ways to control costs.
Healthcare leaders' opinions are as diverse as those on Capitol Hill. Here is what seven health leaders think of the House's reform plan:
Craig E. Samitt, MD, MBA
President and CEO
Dean Clinic and Dean Health System
"Admittedly, my feelings about recent passage of the House healthcare bill are mixed. On one hand, I applaud the fact that we're finally seeing progress toward significantly broadening access and reforming healthcare, particularly the insurance market. The U.S. healthcare system needs repair and true healthcare reform is long overdue.
"On the other hand, the healthcare bill that marginally passed in the House is not true reform, and frankly does not go far enough to address what is truly broken in our healthcare system. If we truly want to reform healthcare, this would involve four critical elements.
"First, solve the uninsured dilemma by assuring that healthcare for all Americans is an equal right, not a luxury. Second, significantly improve clinical quality, patient safety, customer service, and access. Third, solve the 'cost conundrum' that has resulted in our system being an unfathomable 50% more costly than any other country. Fourth, preserve and protect the strengths of the current system and create a combination of carrots and sticks to address what is truly wasteful, fraudulent or broken.
"While the House healthcare bill assures broader coverage for the uninsured, which is good, it does little to address concerns about quality, service, safety, access or cost. If we truly wish to reform our healthcare system into one that assures better care at a lower cost, we need to go further."
Rich Umbdenstock
President and CEO
American Hospital Association
"While the House bill makes important progress in expanding coverage, an important goal for hospitals, there are areas for improvement. In the days ahead, America's hospitals will work to improve upon the bill for patients and families.
"While the House bill using negotiated rates within parameters is an improvement, we remain concerned that the program would still, in part, be based on historically low Medicare rates. We also are concerned about expanding eligibility for Medicaid to 150% of the federal poverty level at a time when states are struggling with severe budget shortfalls.
"Lawmakers also should restore a provision that would expand the outpatient $340 billion drug discount program to inpatient services for all eligible hospitals. Lawmakers should revise the $20 billion medical device manufacturer tax so it cannot be passed on to hospitals, narrow the hospital readmissions policy to address only truly avoidable readmissions, and improve accountable care organizations to give hospitals the opportunity to play a leadership role."
Lori Heim, MD
President
American Academy of Family Physicians
"The House passage of the Affordable Health Care for America Act is an important step toward needed change in the healthcare system.
"This legislation will provide health insurance coverage for 96% of Americans. It will provide peace of mind for millions of people who cannot get health insurance due to cost or pre-existing conditions. It will provide health security for millions more who fear loss of coverage if they get sick.
"Family physicians appreciate the bill's provisions that would help re-establish primary medical care as the foundation of our healthcare system. Investment in primary care will yield not only better health for everyone, but also more efficiencies, less waste, and less duplication.
"By creating a pilot program that helps physicians provide patient-centered medical home services and eliminating out-of-pocket expenses for preventive services, the legislation will encourage Medicare beneficiaries to get the comprehensive, whole-person care that improves their health while helping control the cost of their care.
"HR 3962 also begins rectifying the growing payment disparity between primary care and subspecialty care physicians. The bill provides a Medicare-wide, 5% bonus (10% in underserved areas) for physicians whose Medicare practice is more than 50% primary care services. This bonus sends a signal that the nation does, in fact, recognize and value the medical expertise and comprehensive care provided by family physicians and their primary care colleagues."
Alan Morgan, MPA
Chief Executive Officer
National Rural Health Association
"For health reform to be effective for the quarter of the population that resides in rural America, the access to care crisis in rural areas must be resolved. To do that, health reform must address the workforce shortage crisis in rural areas and correct long-standing payment inequities.
"The House healthcare reform bill takes positives steps toward both of these goals, but falls short of truly ensuring that the access to care crisis will be significantly reduced."
J. James Rohack, MD
President
American Medical Association
"The AMA hails the passage of the House health reform bill, which will help improve the health system for patients and physicians and calls for swift passage of HR 3961 to secure the stability of the Medicare program. Passage of the House health reform bill is a big step forward as we work for comprehensive health reform this year. The AMA will continue its work with Congress and the administration to strengthen and improve health reform legislation as the process continues for patients and physicians.
"The bill will significantly expand health insurance coverage to Americans; empower patient and physician decision making; institute meaningful insurance market reforms; make substantial investments in quality; institute prevention and wellness initiatives; provide incentives to states that adopt certificate of merit and/or early offer liability reforms; and reduce administrative burdens.
"As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled through passage of the Medicare Physician Payment Reform Act of 2009 (HR 3961). This bill will permanently repeal the broken physician payment formula and preserve access to care for seniors, baby boomers and military families."
Karen Ignagni
President and CEO
America's Health Insurance
"Health plans strongly support comprehensive healthcare reform, and we have contributed to this discussion by proposing a complete overhaul of how health insurance is provided. Earlier this year, we proposed guaranteed coverage, elimination of pre-existing condition exclusions, no longer basing premiums on a person's health status or gender, and an effective personal coverage requirement to get everyone covered. We also have proposed far-reaching administrative simplification reforms that will improve efficiency, reduce costs, and free up time for physicians to focus on patient care.
"The current House legislation fails to bend the healthcare cost curve and breaks the promise that those who like their current coverage can keep it. A new government-run plan will cause millions to lose their existing coverage and draconian Medicare Advantage cuts will force millions of seniors out of the program entirely.
"This bill imposes inflexible mandates before getting everyone covered and new regulations that duplicate what is already in place at the state level. Many of these reforms begin in 2010 after employees have already chosen their plans and contracts have been negotiated. The result will be increased costs and massive disruptions in the quality coverage individuals and families rely on today."
Margaret A. Murray
Chief Executive Officer
Association for Community Affiliated Plans
"The labels 'historic' and 'landmark' are often overused, but they certainly apply to the House's passage of health reform legislation. This courageous action is a giant step forward and a major victory for reform over the status quo. The House bill takes the right approach to expanding access to affordable coverage, making all Americans more secure, and protecting critical programs for the most needy and vulnerable.
"The most positive aspect of the legislation is the largest expansion of Medicaid since the program was created more than four decades ago. Expanding Medicaid to cover everyone up to 150% of the federal poverty line is the most straight-forward and cost-effective way to provide coverage to those who reform should help the most—low-income Americans who have been the most ill-served by the deficiencies in our current system. This change alone will provide coverage to at least 15 million more Americans. And it will ensure that they get the kind of high-quality, comprehensive services they need and deserve at a price they can afford.
"The Senate should follow the House's lead and pass a strong reform bill without further delay."