The health-care bill passed Nov. 7 by the U.S. House of Representatives has moved the nation a step closer to enacting health reform but several strides from the finish line.

"At no time in history has either chamber -- the House or Senate -- passed a bill that would expand coverage to the vast majority of Americans while still making other investments in important things like the primary-care physician workforce, payment and delivery system reform and other priorities like that. That's huge," said Bob Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians.

But with 2009 drawing to a close, it's become crunch time on Capitol Hill. First the Senate still must pass a bill, and Senate Majority Leader Harry Reid (D-Nev.) has suggested that it might not do so before Christmas. Then representatives from both chambers must resolve differences between the two measures.

"That's going to be another whole stage of negotiation and advocacy for ACP," Doherty said. That's where we have to weigh in very clearly on the provisions we like from each bill and the ones we want eliminated or modified."

ACP will evaluate the Senate version the same way it did the House Democratic bill and the Republican alternative: by comparing each provision against the college's core priorities, Doherty explained.

Only after each chamber has approved a compromise version can health reform legislation advance to the president's desk for signing.

The Senate bill, which is expected to be brought to the floor soon for debate, will undoubtedly reflect legislation passed by the Finance Committee in October and the Health, Education, Labor and Pensions Committee in June. But details of its final form remain a mystery.

"It's a little bit of a black box right now to know what's going to be in that bill," Doherty said.

The House bill, cleared by a 220 to 215 vote, advances a top ACP priority by expanding coverage to 96 percent of Americans and providing federal subsidies to help low-income individuals and families purchase health insurance.

The bill also includes incentives to bolster the primary care workforce, another ACP priority. By 2012, primary-care practitioners who serve Medicaid patients would earn 100 percent of what Medicare pays. Beginning in 2011, primary-care practitioners serving Medicare beneficiaries would be eligible to receive a 5 percent bonus, or 10 percent if they practice in an underserved area.

And on medical liability reform, another of ACP's primary goals for reform, the bill does not go as far as the Republican alternative. The House version would provide incentive payments to states that enact an "alternative medical liability law" resulting in prompt and fair dispute resolution, disclosure of health-care errors and access to affordable liability insurance. But to quality for payments, state laws must not limit attorneys' fees or impose caps on damages.

The House bill includes a public health insurance option but would not limit provider reimbursement to Medicare rates. Providers would be able to negotiate rates with the government plan as they would with any private plan.

Sen. Reid has indicated that the Senate version will include a public plan option but, in a nod to conservatives, that there will also be a provision allowing states to "opt out."

That move is considered among the many compromises that could be needed to secure the 60 votes that it will take to move legislation ahead.

"If we don't get 60 votes in the Senate, at some point the whole thing falls apart," Doherty said.