On November 7, 2009, the House of Representatives approved H.R. 3962, the Affordable Health Care for America Act, by a vote of 220 – 215. The legislation seeks to expand access to affordable health insurance coverage (including through the creation of a public health insurance option) and institute numerous reforms to the nation’s health care system. The most polarizing issue during the House debate, however, was coverage of abortion services (the House ultimately adopted an amendment prohibiting federal funds for abortion services in the public option and prohibiting individuals who receive insurance subsidies from purchasing a plan that provides elective abortions). Also during floor debate, the House incorporated a “manager’s amendment” to the bill that make a number of changes to the version of H.R. 3962 released October 29, addressing such issues as verification of citizenship for health coverage, insurance industry practices, optional state funding for long-term care facility background checks, enhanced oversight of claims for new medical equipment suppliers, Medicaid community support services, and specialty hospitals, among others. The House also approved a “rule” that allows Congress to consider separate legislation, H.R. 3961, the Medicare Physician Payment Reform Act of 2009, which would provide a permanent fix to the Medicare physician fee schedule formula (physicians are facing a 21.2% across-the-board cut in Medicare payments January 1, 2010 in the absence of statutory change). Our previous summaries and updates on the House bill are available here. Legislative action now shifts to the Senate, where leaders have been working to meld bills adopted by the Senate Finance Committee and the Health, Education, Labor, and Pensions (HELP) Committee. The consensus bill being developed is still under wraps while the Congressional Budget Office “scores” its fiscal impact. Senate leadership still hope to release the bill within the next week and to begin what is expected to be a lengthy floor debate on the package before Thanksgiving, although that timeline is subject to change.