The Senate has approved a massive health reform package, marking the first time in history that both chambers of Congress have passed comprehensive legislation seeking to ensure that nearly all Americans have health coverage.
The final vote came five weeks after the Senate started to vigorously debate the bill and two months after the Finance Committee approved what would become the framework for the legislation.
All 60 members of the Democratic Caucus voted for the bill, which failed to gain a single Republican vote. For providers and insurers, the 10-year, $871 billion package would bring sweeping changes in healthcare financing aimed at insuring 31 million Americans who currently have no coverage.
For starters, insurance companies would no longer be able to deny coverage based on pre-existing conditions or to dump patients who become ill.The legislation also creates a new health insurance “exchange,” a marketplace where private health plans would compete for a share of the newly insured and others.
Within the exchange, the Office of Personnel Management, which oversees the federal employees' health benefits program, will oversee two national or multi-state plans.
The federal government would subsidize many of the new enrollees in the exchange.
Republicans, united in their opposition, however, said that the bill would bankrupt the government while doing little to corral the soaring increases in healthcare costs.
“This bill is flawed and there is nothing you can do to overcome it,” Sen. Bob Corker (R-Tenn.) said.
Corker, a vocal critic of the bill, however said that parts of the legislation—including measures to create a health insurance exchange and those that waive certain insurance company practices—are workable. “But again, the bill is built on a foundation that is flawed.”
Similarly, the insurance industry found fault with the bill.
“At the same time, specific provisions in this legislation will increase, rather than decrease, healthcare costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses – particularly between now and when the legislation is fully implemented in 2014," said Karen Ignagni, head of the trade group America's Health Insurance Plans, in a written statement.
“These issues can and should be addressed if health care reform is going to fulfill the promise of providing all Americans with guaranteed access to affordable, portable health care coverage," Ignagni said.
The bill now goes to a House-Senate negotiating committee, which must meld the two similar but widely divergent measures into a single piece of legislation that proves palatable to both chambers. The process is expected to start in January and could run into February.
The legislation was supported by an array of provider groups, including the American Hospital Association, the Federation of American Hospitals and the American Medical Association.
"For years, America's hospitals have worked to make coverage for all a reality," AHA President Rich Umbdenstock said. "With passage of today's bill, we are closer to that goal."
Umbdenstock said that the legislation "begins to lay a solid foundation for coverage, delivery and payment reforms that can help hospitals provide quality care to more people."
Under a deal sealed earlier in the process, the nation's hospitals are largely shielded from steep payment cuts over the next 10 years. In return, however, hospitals will see federal compensation for treating the poor and uninsured greatly reduced.
But a number of pilot programs set out in the bill are designed to change how hospitals are compensated, moving towards a bundled system of payments.
Physicians also have a deal in place with lawmakers. A provision added to the bill late in the process actually strips the legislation of a measure that would have replaced a 21% Medicare pay cut with a 0.5% increase in 2010.
In return, however, lawmakers promised the physician groups that they would seek a longer-term fix to the flawed Sustainable Growth Rate formula.
Cecil Wilson, the president elect of the American Medical Association, came out in support of the bill, lauding reforms meant to increase access and eliminate pre-existing conditions.
“America has the best healthcare in the world—if you can get it,” he said. “But for far too many people, access to care is out of reach because they lack insurance. This is just not acceptable to physicians who provide high quality of care in an often fragmented system that doesn't work for them or their patients.”
The Senate vote follows a long tradition of initiatives by U.S. presidents to expand healthcare coverage. It comes nearly a century after Theodore Roosevelt first proposed a form of national health insurance for all Americans.
Plans to obtain universal coverage in Social Security legislation were set aside by President Franklin Roosevelt in the face of opposition from the AMA. Republican opposition in Congress shot down a similar proposal by President Harry Truman.
More recently, an effort spearheaded by President Bill Clinton and then first lady Hillary in the early 1990s landed on the Hill with a thud.
Democrats spent all of this year pushing what has become President Barack Obama's singular domestic issue, watching as negotiations ate up almost all of the legislative calendar—and any good feelings between the two parties.
“I think there are probably some bruised feelings on both sides,” Sen. Richard Durbin (D-Ill.) said. “It's a good time to go home and be with our families.”
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