Before narrowly voting Nov. 7 in favor of the health-reform plan offered by its Democratic majority leadership, the U.S. House of Representatives rejected a substantially less expensive and streamlined alternative offered by House Minority Leader John Boehner (R-Ohio).

The American College of Physicians had expressed broad support for many of the key policies in the bill that passed the House (H.R. 3962), as they have long been advocated by the organization. By comparison, ACP found that the GOP proposal did not meet most of the college's key priorities for health reform. ACP evaluates legislation based on consistency with ACP policy, independent of partisan consideration, according to Bob Doherty, senior vice president of governmental affairs and public policy.

"We have been very clear from the beginning that the ACP supports expanded coverage that leads to coverage for all Americans," Doherty said.

It's estimated that the measure approved by the House would reduce the ranks of the uninsured by 36 million, resulting in coverage for 96 percent of legal, non-elderly residents by 2019, according to an analysis by the nonpartisan Congressional Budget Office (CBO). By contrast, the CBO found that the GOP measure would have covered only an additional 3 million people, leaving the percentage of uninsured in the country virtually unchanged.

To ensure broad insurance coverage, the plan passed by the House also provides federal subsidies to help low-income individuals and families purchase health insurance. The Republican plan provided no such assistance.

The GOP alternative did allow individuals to purchase insurance across state lines, a change designed to help people access more affordable insurance plans. But those plans are regulated by the states in which the insurance is sold, leaving buyers in other states potentially vulnerable to weaker consumer protection laws, Doherty noted.

The ACP also has been a staunch proponent of primary-care incentives because, as Doherty explained, "giving somebody an insurance card doesn't give you access if there are no primary care doctors."

The bill passed by the House would spend $57 billion over 10 years to increase Medicaid payment rates to physicians and other health-care professionals for primary-care services. It also includes a 5 percent Medicare bonus for primary-care services and supports a national demonstration of the "medical home" concept. The GOP bill did not include such workforce or payment reform provisions.

Though neither version fixed the formula that leaves physicians exposed to a 21 percent Medicare payment cut in 2010, separate legislation recently introduced by House Democrats would repeal the "sustainable growth rate" formula.

Of ACP's top priorities -- expanded coverage, incentives to bolster the primary-care workforce, Medicare payment reform and medical liability reform -- "the only one where the Republican bill really was superior . . . was medical liability reform," Doherty said. "And we certainly support that part of their bill."

The Republicans also proposed capping non-economic damages at $250,000, establishing a three-year statute of limitations on bringing a case and other protections.

With an estimated net cost of $8 billion over 10 years, the GOP measure was 11 times less expensive than the version House Speaker Nancy Pelosi (D-Calif.) shepherded through the chamber. However, in ACP's assessment, the lower price tag did not translate into better policy.

"The issue in terms of what you're spending money on is, 'You get what you pay for,' " Doherty said.