(cross-posted at CureThis)

The US Senate convened today — the day before Christmas — and passed the Senate’s version of the famed health insurance reform bill, the Patient Protection and Affordable Care Act. This bill will move into conference committee with the House of Representatives’ version of the bill in January, before final passage. It is not a common occurrence to meet the day before Christmas. The last time the Senate held a roll call on Christmas Eve was in the year 1895, when Senators lifted a ban on government officers who had joined the Confederacy from serving in the post-Civil War military. Below are other interesting facts about the Senate.

• Today (Christmas Eve) marked the 25th straight day of debate. This is just short of the record for the longest number of consecutive days that the Senate was in session, in the winter of 1917 (thanks to @wonkroom on Twitter for this fact). The extended debate in 1917 was due to anti-war legislators stalling debate about whether or not to arm US merchant ships during World War I.
• The Christmas spirit inspired some poetry this week, from Illinois Senator Burris. He took to the mic and started with “It was the night before Christmas and all through the Senate, the right held up our health care bill, no matter what was in it.” …and he went on from there [link to poem transcript and video. Then, the New York Times, uninspired by the average poetry and meter of Burris’s rhymes, challenged its readers to think up more rhymes. Readers’ submissions are quite entertaining.
• On the etymology of filibusters: “The term filibuster was first used in 1851. It was derived from the Spanish filibustero meaning pirate or freebooter. This term had evolved from the French word flibustier, which itself evolved from the Dutch vrijbuiter (freebooter). This term was applied at the time to American adventurers, mostly from Southern states, who sought to overthrow the governments of Central American states, and was transferred to the users of the filibuster, seen as a tactic for pirating or hijacking debate.” (from Wikipedia)
• The longest running filibuster in US history was over 75 hours, when southern Senate Democrats tried unsuccessfully to block the passage of the Civil Rights Act of 1964.
• The filibuster and its buddy — the cloture vote (the supermajority vote of 60 Senators needed to overcome a debate-halting filibuster) — were invoked 112 times after the 2006 mid-term elections and projections continue to rise, rendering our American democracy subject to the whims of a few Senators. Here’s are two representations of the increased numbers of filibusters and cloture votes — in table format and in chart format.
• And an excerpt from President Obama’s remarks on today’s vote: “As I’ve said before, these are not small reforms; these are big reforms. If passed, this will be the most important piece of social policy since the Social Security Act in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s. And what makes it so important is not just its cost savings or its deficit reductions. It’s the impact reform will have on Americans who no longer have to go without a checkup or prescriptions that they need because they can’t afford them; on families who no longer have to worry that a single illness will send them into financial ruin; and on businesses that will no longer face exorbitant insurance rates that hamper their competitiveness. It’s the difference reform will make in the lives of the American people…”

January will bring a new year and the start of heated discussions among legislators, lobbyists, and advocacy organizations to reconcile the major differences in the Senate and the House versions of the health insurance reform bill. The National Physicians Alliance is working hard with other organizations, to try to strengthen the affordability provisions and improve the bill.

To the NPA Community,

It has been a tough week for health care reform.  As I write this letter, the public option, in any form, is no longer under consideration in the Senate bill and there are not 60 definite votes in the Senate for the compromise legislation.  Without 60 votes to end debate, health reform is over and the status quo wins.  This series of events in the Senate has left me angry, frustrated, and incredibly disappointed.

During the last 11/2 years it has been my privilege to serve as the Chair of NPA’s Secure Health Care for All Campaign.  I have watched with great NPA pride as thousands of you around the country have responded to numerous opportunities to stand up and amplify your patients’ voices in support of reform that would result in quality, affordable, health care for all.  Together, we have worked tirelessly to establish the choice of an affordable public health insurance option open to all; regulation of private health insurance companies; delivery system reforms that promote quality over quantity; and to guarantee health care as a basic human right.

It is now likely that not all of NPA’s goals are going to be achieved in the final bill.  Some nationally prominent voices are advocating that the Senate bill must not pass.  As I struggle to contain my personal anger with the Senate proceedings, I constantly return to the NPA mantra:  “put patients first.”

Although there will be no public option, there will be many benefits for patients in the final bill.  This legislation will enable 30+ million currently uninsured Americans to have access to quality health insurance and establish critically important regulation of private health insurance companies.  These companies will be prohibited from denying coverage for pre-existing conditions, from dropping individuals who become ill, and from establishing annual and lifetime spending caps.

Additional provisions create a floor on how much of the health insurance premium dollar must be spent on health care, establish processes for reviewing increases in health plan premiums, promote administrative simplification, and provide coverage for dependent children up to age 26 (House) or 27(Senate).  The House bill removes the anti-trust exemption for health insurers and medical malpractice insurers and contains strong provisions requiring federal standards for insurance plan transparency, disclosure and data collection.  It appears that the Senate will join the House in adding language to close the Medicare Part D donut hole.

Finally, the most important result of this legislation is that the principle that every American must have access to affordable health insurance will now be part of our law.  Future discussions in Congress will no longer center on whether all Americans should have access to care but on how we get this done.

Let’s be clear, there is much to be done to protect our patients.  The Senate bill in particular contains seriously inadequate affordability provisions for low-income people; weak mechanisms to increase insurance company competition and decrease health insurance premiums; and insufficient regulation of private health insurance companies.  This process is not over and just as none of us would abandon a chronically ill patient, the NPA is in this fight for the long run. Until final passage, we will continue to advocate for the strongest possible bill.  Looking forward, the horizon is filled with substantive issues concerning implementation, delivery system reforms, and affordability.  There will be important issues at the state and local level.  The NPA will be there throughout, standing with our patients demanding a just health care system.

Please let me know what you think.  You can make public comments in response to this letter on our blog: http://www.npalliance.net/blog/.  This letter will be posted on that website, and we welcome you to click “Comment” at the end of the letter and share your thoughts.  Or, if you prefer, submit private comments to our Board of Directors at npa@npalliance.org.  We want to hear from you about the current bill and what you believe to be the most critical issues that NPA should be alert to as we all go forward.

I am still frustrated, angry, and incredibly disappointed but I am not walking away. We are at the beginning of health care reform – a process that is going to require engagement, commitment, and stamina to get secure health care for all.

Count me in.

Val

Valerie Arkoosh, MD, MPH

Chair

Secure Health Care for All