President signs Health Reform into Law; But Many Issues Remain

The President signed health care legislation into law today. Today's ceremonies followed a very busy weekend in Washington DC with the House approving late Sunday night the Senate Health Reform bill and Reconciliation Language.

The House took two separate votes on the reform legislation. First, the House passed - by a vote of 219 to 212 - HR 3590, the Patient Protection and Affordable Care Act, the bill approved by the Senate last December. The House then passed HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010, by a vote of 220 to 211. This legislation modifies the Senate bill with a number of "fixes" negotiated over the last two months by the House and Senate. As expected, not a single House Republican voted in favor of either measure.

The contentious, year long health reform debate is not finished, however, as H.R. 4872 goes to the Senate, where only a simple majority is needed to approve the bill under the reconciliation process. The Senate will consider the modification bill under streamlined procedures that avoid time-consuming cloture motions to begin and end debate on the bill. Senate Republicans are expected to offer numerous amendments and raise multiple points of order to the legislation. If the bill is changed in any way prior to Senate approval, it must return to the House for an additional vote before the President can sign it. A timeline on the Senate debate of the reconciliation measure has not yet been officially released but is expected to proceed quickly given the upcoming Spring recess which is supposed to start at the end of the week.

Even with passage of the most historic health reform legislation since the enactment of Medicare, policy insiders anticipated a reinvigorated battle over the future of Medicare as the Senate considers the reconciliation language. Also expected on the horizon are appropriations funding battles for the provisions of the bill of discretionary spending provisions and threats of court cases in several states over requiring individuals to purchase health insurance.

The Senate this week will also consider a new short-term extension bill (HR 4851) to extend the delay in Medicare physician rate cuts until April 30. The current extension expires on March 30. The House approved the measure on Wednesday. The Senate approved a longer-term extension (HR 4213) earlier this month which is pending action in the House. This is one of several critical issues yet to be addressed. Next up...the real work begins on the implementation of health reform.