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Health Reform is Here: "This is what change looks like."

IMG_3817After a year of contentious debate, Congress has finally passed the health care reform bill, which provides coverage to 32 million currently uninsured Americans and regulates the insurance industry.

Just before midnight Sunday, the House passed the measure by a vote of 219 – 212, with unanimous opposition from the Republican party.  The bill required 216 votes for passage.  The House also passed a second piece of legislation, the reconciliation bill that made corrections to the Senate version, by a vote of 220 – 211.

After the session ended, President Obama gave a brief public address and said that the bill “isn’t radical reform. But it is major reform. This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.”

The bill will now go back to the Senate for a procedural vote on the reconciliation changes approved last night and then to the President for him to sign into law.  There is a chance that Republicans may try to stall the bill in the Senate.

As Obama described the next steps: “On Tuesday, the Senate will take up revisions to this legislation that the House has embraced, and these are revisions that have strengthened this law and removed provisions that had no place in it. Some have predicted another siege of parliamentary maneuvering in order to delay adoption of these improvements. I hope that’s not the case.”

However, Obama’s former nemesis, Sen. John McCain (R-Nev) had different thoughts of the bill and its future.  McCain told ABC’s Good Morning America that Republicans “will challenge (the bill) every place we can.”  He called the bill “terribly wrong for America” and said that “outside the Beltway, the American people are very angry. They don’t like it and we’re going to repeal this.”

The bill will eventually affect just about every American by 2014 when fines will be imposed upon people who do not buy or have insurance.  For patients interested to know how the bill may affect or benefit them, refer them to this outline in the New York Times.  Also, you may be interested to read about ten immediate benefits of this bill that will take effect upon the President’s signature.

Now, for the docs.  How does the health reform bill affect physicians?  The consensus is that 32 million newly insured patients ultimately would result in more business for physician practices and hospitals.  However, it remains unknown just how much docs and hospitals will be paid.  The bill did not include any permanent remedy to the annual cuts to Medicare reimbursements.

The bill does include an incentive for only primary care docs to accept more Medicaid patients as it increases those reimbursements to equal Medicare.  But the crush of new patients combined with the uncertainty of those payment rates and the exclusion of specialists may lead to problems.

The American Medical Association announced its support of the passage of the bill.  But Dr. J. James Rohack, president of the AMA, included some caveats in his approval: “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 health care delivery.”

The Texas Medical Association was less diplomatic in its opinion of the bill.  Dr. William Fleming, president of the TMA, said “”We are disappointed and saddened that Congress and President Obama would pass a half-baked Senate proposal and call it ‘Health System Reform.’ The bill is simply bad medicine for patients and the state of Texas.”

Dr. Lori Heim, president of the American Academy of Family Physicians, said “”Although this bill is not perfect, the AAFP consistently supported efforts to provide health insurance with a minimum package of benefits for all Americans; to deliver high quality, comprehensive, and preventive care in a patient-centered medical home; and to ensure people can see their personal physician when they need care.”

We will continue to provide updates of this historic legislation.  Meantime, tell us your opinions.  Discuss below with your colleagues how this bill may affect you, your patients, and your practice.


  1. With Primary care:
    Medicaid for children does not cover the cost the physician has to pay out for these children to be seen now. The overhead: i.e. employees, supplies, utilities, payroll taxes and the list goes on. Anyone that is in private practice knows this to be true. How can physicians continue to provide quality health care to these children when each year their cost goes up and reimbursments drops.

    What will happen if physicians start closing their practices or should I say forced to! Where will all these newly covered patients go for health care?
    Just a thought!!

    p.s. If physicians have the choice to become a provider; do you really think they will choose to knowing it will force them to close!!!

  2. President Obama campaigned on this very issue. This is what the people voted for. This isn’t “in clear defiance of the wishes of the the people.” No matter how many times you repeat this, it doesn’t make it come true!

  3. Obama will see what Change really looks likes coming this November.

  4. What a stunning insult this is to those of us who have dedicated our lives to the task of balancing reason with instinct, and science with art, for the good of our fellow people, while also helping our families and friends with the benefits of our labor. 220 people with great power, low cunning, and absolutely no common sense have financially enslaved us, pilloried the country, and allowed their good friends the Tort lawyers to roam as free as ever.

    Thank yous are due to J. James Rohack, Atul Gawande, and countless other physicians whose lack of true understanding and sanctimonious selfrighteousness has encouraged all of this to happen. Your spineless lack of leadership has led not only physicians, but the very health and vitality of this country–for all small businessmen I treat are totally against this bill as well–to its worst hour in decades.

  5. This bill does not “reform” health care OR health insurance (terms that have been used interchangeably by the Obama administration and members of Congress). This bill places an additional tax burden on employers (who are the job creators), but even worse, it burdens every American with the requirement to purchase health insurance even if he/she doesn’t wish to. At best, Obama and Congress are overriding the wishes of the majority of Americans because they believe they know better. At worst, they overrode the wishes of the majority because they don’t care what we really want and they saw an opportunity to grab even more power and influence for the federal government.

    They are working toward single-payer (i.e., health insurance through only the government). And why not? They’ve done a great job of Social Security, Medicare, and Medicaid, right? RIGHT?!

  6. Dear Sirs,
    Reading the arguments about “socialism” and the associated histrionics that are published here, begs the question, “what is the benefit for the subject of our care: the patient.” We live in a capitalist society where renumeration is the only aspect of life that is of importance. Most physicians, I believe entered the profession because they felt they would benefit patients by restoring them to health and not “for the money” for if they did, they would be businessmen. I trust that most physicians will not agree with the above comment. The purpose of the profession is to benefit out patients for we have sworn this as part of our oath. Put the name-calling aside and do what is best for humanity and our nation without needlessly sacrificing ourselves.

  7. This is what arrogance looks like- when a body of supposed representatives of the people ram through more government control, in clear defiance of the wishes of the the people. This is what a step closer to Socialism looks like – when President Obama and Speaker of the House Pelosi are convinced they have all the answers and know better than the American public what the American public needs so they determine what the American public gets. This is what egoism looks like – when people elected by other people to carefully follow the mandates of the Constitution and preserve a Republic, instead ignore both the Constitution and the People in order to leave behind for themselves a “legacy”. This is not a case of, “Look what we did to make things better for you; this is a case of, “Look what we did, aren’t we wonderful? Boy, won’t cement my place and my party’s place in power?” It should be remembered by all that, “Power corrupts, and absolute power corrupts absolutely.

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