With fiery oratory, name calling, and plaintive pleading that marked much of the last 13 months of healthcare debate, lawmakers finally passed historic reform legislation with a vote of 219 to 212, three votes more than they needed.
Leaders will have to figure out how the government will implement and administer the numerous provisions over the coming months. And many key mandates of the new law won't take effect for years.
But what do health leaders think of Sunday's health reform vote? Here are the thoughts of 11 leaders:
President and CEO
American Hospital Association
"For years, America's hospitals have worked hard to make coverage for all a reality.
"Today, a historic and long overdue step was taken toward achieving that worthy goal. This bill, which we support, will make a real difference in lives of millions of Americans.
"Healthcare is at a tipping point and the shortcomings within our healthcare system can no longer be ignored. Today's vote will chart a new and better course for our nation's health and healthcare. Bottom line: the health reform bill may not be perfect, but it expands coverage to 32 million people, enacts significant insurance market reforms, and lays a solid foundation upon which we can continue to build."
President and CEO
America's Health Insurance Plans
"The access expansions are a significant step forward, but this legislation will exacerbate the healthcare costs crisis facing many working families and small businesses."
Senior Vice President
Institute for Healthcare Improvement
"Historically, I have been worried over whether we as a healthcare industry had the individual and collective guts to drive change with this level of complexity. What I've have seen over the last five years in Massachusetts, says 'yes' and what I have seen in the last year nationally in the collective conversations and actions of the healthcare industry says 'yes.'
"Besides, as a leadership community, we must honor those we are privileged to serve and get on with it now. Look at the amazing opportunity we have been given and we have no other option."
J. James Rohack, MD
American Medical Association
"Historic passage of health system reform . . . is an important step toward providing coverage to all Americans and improving our nation's health system. Every day, physicians see the devastating effect being uninsured has on the health of our patients.
"While the House-passed bill isn't perfect, we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans.
"By extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and the physicians who care for them. There are increased payments for primary care physicians caring for Medicaid patients and bonus payments for physicians in underserved areas.
"Those who have insurance will see improvements right away: lifetime caps on coverage end; children can stay on parents' policies until age 26, and insurance companies can't cancel coverage except in the case of fraud.
"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 healthcare delivery.
Center for Medicare Advocacy
"[House lawmakers] had the courage to protect the interests of the 32 million Americans who lack health insurance and the 45 million Medicare beneficiaries who need added protections rather than the interests of insurance companies.
"The measure passed today provides access to health insurance for millions of Americans, provides subsidies to those with limited incomes and resources, improves access to preventive services, and limits discrimination in the offering of health insurance.
"The bill protects the integrity of the Medicare program by reducing overpayments to private Medicare plans and by promoting delivery system reforms to encourage high quality, coordinated health care. The bill further assists people with limited means by extending eligibility for Medicaid for the under 65 population."
Joseph W. Stubbs
American College of Physicians
"This historic measure advances long-standing ACP policies to provide all Americans with access to affordable health insurance coverage. It fills gaps in our current system by providing families and small businesses with competitive and portable private sector options to buy affordable coverage, providing subsidies when they need help, and ending egregious insurance company practices that deny patients with pre-existing conditions access to affordable coverage.