With the U.S. Senate's historic Christmas Eve passage of health-care reform legislation, Democratic leaders in both chambers of Congress are turning their attention to engineering a compromise.

Amid that process, the American College of Physicians' goal is to ensure that bargaining among congressional negotiators and the White House doesn't sacrifice key ACP priorities for reform.

"The biggest issues for us are going to be to get the strongest provisions in there to help avert a shortage of primary care physicians," said Bob Doherty, the ACP's senior vice president of government affairs and public policy.

Both bills significantly expand access to health insurance coverage. Under the bill passed Nov. 7 by the U.S. House of Representatives, the number of Americans without health insurance is projected to decline by 36 million people by 2019. The Senate bill would reduce the ranks of the uninsured by 30 million over the same time period.

"We have been concerned all along that there are not going to be enough frontline primary care physicians to take care of the surge in the covered population," Doherty said. "And both bills do have significant reforms to support primary care -- creation of a national workforce commission, scholarship and loan repayment programs and increased Medicare payments to primary care -- but there are also significant differences."

Each bill has its strengths and weaknesses so it's not as though one bill is "better" than the other, Doherty explained.

Both the House and Senate bills, for example, support expansion and testing of the Patient-Centered Medical Home and expand funding for the National Health Service Corps.

"Our continued goal will be to get a final bill that has, again, the best of the programs from each chamber's respective bills, with modifications in those if necessary, so that when a final bill is signed into law, we can say that it creates a structure and a foundation at least for policies to begin to reverse the primary care shortage," Doherty said.

On medical liability, the House bill creates a grant program to encourage states to adopt alternatives to medical malpractice lawsuits that would result in prompt and fair dispute resolution. The Senate bill creates a similar grant program to encourage innovative alternatives to litigation. Under both the House and Senate proposals, states could not use the federal grant money to fund reforms that would include caps on non-economic damages or limits on attorney's fees, but states would not be restricted from enacting and funding such limits on their own. States that already have limits on damages and attorney fees could keep those reforms and still apply for funding to test other alternatives to improve patient safety and create alternatives to costly tort litigation.

Democratic leaders are hoping to deliver a bill to the president by late January or early February. However, the health-care advocacy process will continue long after a bill is signed into law.

"Health-care reform is not a destination," Doherty insisted. "It's more like a continuous journey," much as Medicare, a program created in 1965, has been amended continuously since its enactment.

Regulations must be written to implement the legislation. Many stakeholders will begin haggling over various provisions of the law, some of which might not take effect for several years. And appropriations committees must decide how much money to put into various programs authorized by the legislation.

"This is a dynamic process that's going to continue, which will give ACP the ability to continue to advocate for improvements to address the College's priorities on coverage, workforce, payment and medical liability reform, even after a bill is signed into law," Doherty said.