One Step Closer

This morning, just a few minutes after 7:00 AM eastern time, the Senate passed H.R. 3590, the Patient Protection and Affordable Care Act, by a vote of 60-39. All Democrats and two Independents voted for the legislation; all but one Republican voted against the bill (Sen. Jim Bunning (Ken.) did not vote).

This action brings the Congress one step closer to culminating more than 70 years of attempts by the federal government to expand health care access and coverage.

The modern era of government involvement in health began in 1965, when President Lyndon Johnson signed the Social Security Act of 1965, which established the Medicare program for individuals ages 65 and older and the Medicaid program for low income individuals.

During the next four decades, Congress and the White House attempted a variety of health care reforms, some successful, some not. Enacted legislation included the following:

• Medicare as secondary payor to employer plans, 1980


• Disproportionate Medicaid payments, 1981


• Medicare prospective payment system, 1983


• COBRA Continuation of Coverage, 1986


• IRC Sec. 89, inlcuding qualification and nondiscrimination rules for health care plans, 1986 (repealed in 1989)


• Medicare Catastrophic Coverage Act (MCCA), 1988 (repealed in 1989)


• Mandated Medicaid coverage for children birth to age 18, 1989 and 1990


• Health Insurance Portability and Accountability Act (HIPAA), restricting use of pre-existing conditions in health insurance coverage determinations, setting standards for medical records privacy, and establishing tax-favored treatment of long-term care insurance, 1996.


• Mental Health Parity Act, 1996, 2008


• Medicare Drug, Improvement, and Modernization Act (MMA), creating a voluntary, subsidized prescription drug benefit under Medicare, 2003.

Early this year, comprehensive health care reform became a priority both for President Barack Obama and the 111^th Congress.

Between July and October, five Congressional committees reported out versions of health care reform: H.R. 3200, America's Affordable Health Choices Act, with versions reported by the House Ways and Means, Energy and Commerce, and Education and Labor Committees; S. 1679, Affordable Health Choices Act, reported by the Senate Health, Education, Labor, and Pensions Committee; and S. 1796, America's Healthy Future Act, reported by the Senate Finance Committee.

The full House then considered H.R. 3962, the Affordable Health Care for America Act, which combined the earlier proposals from the three House committees. The House passed the legislation on a vote of 220-215 on Saturday, November 7.

H.R. 3950 was introduced in the Senate on November 19, amended by majority leader Sen. Harry Reid on December 19, and finally passed this morning.

Democrats continue to insist that a bill will be signed by the 2010 State of the Union Message, reportedly scheduled for January 26 or February 2 of 2010.

Substantial differences in the House and the Senate bills include the structure of a health insurance exchange, the nature of a public option, and financing mechanisms. A conference committee to reconcile the differences between the two bills will be necessary. Although pre-conference negotiations are likely to begin during the Christmas and New Year’s break, the House is not scheduled to reconvene until Jan. 12 and the Senate will not meet again until January 19, leaving little time for final passage before the State of the Union address.

Stay tuned.