Local reaction to U.S. Senate passage of a historic health-care overhaul bill ranged from delighted to disgusted, but a frequent concern was whether the coming flood of newly insured Americans will find a drought of primary-care providers.
The 10-year, $871 billion measure would require most Americans to have health insurance, and would subsidize private coverage to help lower- and middle-income families comply with the mandate. The bill also would add 15 million people to Medicaid, the federal-state health program for the poor.
While calling it "a solid foundation," Pennsylvania State University health-policy expert Chris Calkins said it did little to address the growing national shortage of nurses, family physicians, and internal-medicine doctors - the first line of defense in health care.
"Will economic access actually lead to medical access?" he said.
Chuck Pennaccio, executive director of the nonprofit Health Care for All Pennsylvania, speculated that primary-care doctors, already overextended and underreimbursed, "will simply turn patients away."
Pennaccio, whose group is pushing for a single, government-funded health plan in Pennsylvania, called the Senate bill "a major step backward" because insurance companies would continue to be integral to the system. "This not only strengthens [insurance companies'] stranglehold, it makes it worse by mandating that people buy their product," he said.
Area insurance companies were circumspect in their reactions, issued through news releases.
"We strongly support many of the reforms Congress is considering, such as requiring insurers to accept anyone for coverage regardless of preexisting conditions and not charging higher premiums because someone is sick," Independence Blue Cross said. "But we're concerned with some problematic provisions . . . that will actually make health care even more expensive."
The Senate "has exacerbated the problem of affordability by choosing to pay for reform through billions of dollars in additional taxes on the health-care system which will be transferred to the consumer," Aetna chairman Ron Williams said in a statement.
Negotiations must take place to reconcile differences between the House and Senate versions of the bill.
The Senate dropped a proposal for a government health-insurance plan - the so-called public option. Instead, state-based insurance "exchanges" would be created where individuals and small employers could buy commercial coverage.
David Grande, a physician and health-care expert at the University of Pennsylvania, commended the Senate plan. But he, too, lamented the loss of the public option, saying it would have put "pressure on private insurers to compete."
Sean D. Green, a solo practice primary-care doctor in Ardmore, also had hoped for a public option. He called the Senate bill "horrible." "Insurance companies' interests," he said, "are not my interests as a physician."
The Senate bill would prohibit some of the most detested aspects of commercial plans, including lifetime limits on coverage and denials of coverage because of existing health conditions.
Most reform provisions would be phased in over four years, but one that would be almost immediate would allow children to stay on a parent's insurance plan until age 26, four years more than now.
"Even insurance companies like it because young people tend to be healthy," Calkins said, "and family coverage premiums are higher than individual premiums."