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After decades of failed attempts by a string of Democratic presidents and a year of bitter partisan combat, President Obama signed legislation on
March 23, 2010, to overhaul the nation's health care system and guarantee access to medical insurance for tens of millions of Americans.

Two days later the House and Senate completed passage of a set of fixes to the bills, compromises worked out as part of the complicated legislative
maneuvering that allowed Democrats to achieve their long-sought goal despite having lost their filibuster-proof 60-vote "supermajority'' in the Senate
in January.

The pivotal moment in the long legislative battle came in adramatic Sunday evening vote, when the House on March 21 approved, 219 to 212, the health
care bill that the Senate had passed in December. Republicans, who voted unanimously against the bill in both houses, vowed to make it a central issue
in the fall Congressional campaigns and 21 states filed suit, challenging the requirement that most Americans obtain insurance.

The landmark bill signed by Mr. Obama will provide coverage to an estimated 30 million people who currently lack it. Its passage assures Mr. Obama a
place in history as the American president who succeeded at revamping the nation's health care system where others, notably Harry Truman and Bill
Clinton, tried mightily and failed.

The measure will require most Americans to have health insurance coverage; would add 16 million people to the Medicaid rolls; and would subsidize
private coverage for low- and middle-income people. It will regulate private insurers more closely, banning practices such as denial of care for pre-
existing conditions. The law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office,
which has also estimated that it will reduce the federal deficit by $138 billion over a decade.

The victory for Mr. Obama and the Democratic leaders of Congress came after a roller-coaster year of negotiations, political combat, hearings delving
into the minutiae of health care and a near-death political experience after they appeared to have reached the brink of success. On Nov. 7, 2009, the
House had approved its bill by a vote of 220 to 215, while the Senate passed an $871 billion bill on Dec. 24.

But even as the House and Senate worked to merge their bills, their fate was put in jeopardy on Jan. 19, 2010, by an upset Republican victory in a
special election to fill the Senate seat in Massachusetts held for decades by the late Senator Edward M. Kennedy. That outcome deprived the Democrats
of the 60th vote needed to block a Republican filibuster, and threatened to change the political calculus for wavering supporters in both houses.

After weeks of strategizing, Mr. Obama came out with his own version of a bill -- a step he had long resisted in favor of letting Congressional leaders
shape the measure. After a one-day bipartisan "summit" organized by the White House, he began a final push for passage, making clear that he favored
using budget reconciliation in the Senate to pass the House's changes.

Mr. Obama stumped the country in the days before the House vote, putting pressure on Democrats to rally to the measure, and met with dozens of
individual representatives. House Speaker Nancy Pelosi, who had pushed Mr. Obama to hold fast to the goal of a broad measure even after the loss of
Mr. Kennedy's seat, picked up the support of members one by one in marathon talks. One group of crucial representatives, anti-abortion Democrats,
came aboard at the last minute after Mr. Obama promised to issue an executive order "to ensure that federal funds are not used for abortion services."

Editor's note: This page continues our special coverage capping The Business Journal's 25th anniversary year. Health care leaders offer their views on what their
industries will be like in 2030.
John Rivers
President and CEO, Arizona Hospital and Healthcare Association.
Look into your crystal ball and describe how the health care industry will have changed by the year 2030. "There may be certain sectors of our economy where
forecasting 25 years ahead is possible, but health care is not one of them. What I can state with a high degree of certainty is that medical advances over the next
25 years will undoubtedly eclipse all the advances since the beginning of mankind. The pace of change is accelerating at an exponential rate, and all consumers of
health care will benefit from this."
What are the major challenges the industry will face in reaching its goals over the next 25 years? "Without question, the health care community's biggest
challenges will be work force shortages, increasing numbers of uninsured, and access to the capital necessary to meet the demands of a population that is
growing and growing older. These are difficult challenges that must be met and addressed."
Reality check: How do your hopes for the industry differ from a more practical vision of the future? "I always try to keep my hopes and dreams for the future in line
with what I think is realistically achievable, and health care is no exception. I think that advances in medical care over the next 25 years will be so stunning that
much of what we do today that is considered state-of-the-art will look primitive in comparison. It's going to be exciting!"
Garry Davis
President, Davis Appraisal Services Inc.
Look into your crystal ball and describe how the health care industry will have changed by the year 2030. "The health care industry within the next 25 years will be
one of the major economic employment sectors for the state of Arizona. The amount of jobs as well as physical facilities will increase by 50 percent and over 100
percent for major medical office buildings.
"We have 28 acute-care hospitals in the Valley. In the next 25 years, we're going to add another 50 percent, or 14 acute-care hospitals. We have 163 major
medical office buildings over 50,000 square feet. We're going to have somewhere in the neighborhood of 300."
What are the major challenges the industry will face in reaching its goals over the next 25 years? "The major challenges to the industry will continue to be
government interference and the lack of skilled labor, as well as general labor, to fill the available jobs within the industry.
"The hope is that the health care industry will promote from within and cross train American workers for these vital jobs, versus the continuous in-migration of both
illegal and legal labor from other countries. These are high-paying jobs. We've got doctors and nurses coming in from other countries who can barely speak the
language."
Reality check: How do your hopes for the industry differ from a more practical vision of the future? "The tremendous technological growth within the health care
industry may not be sustainable with the current economic resources allocated to the industry. We're going to have to expand those resources in order to maintain,
much less grow, the industry."
Reginald M. Ballantyne III
Senior corporate officer, Vanguard Health Systems.
Look into your crystal ball and describe how your industry will have changed by year 2030. "Technological advancements will undoubtedly be spectacular while
systemic reformation likely will be disappointing. On the science front, we will experience the reality of 'Star Trek's' Dr. McCoy. Medicine will have turned what were
once debilitating conditions, including Alzheimer's, into ailments as treatable as seasonal allergies.
"Infants will undergo genetic profiling, allowing physicians to prescribe drugs precisely tailored to patients' genetic makeup throughout their lifetimes. In
nanomedicine, surgeons seek out and destroy minuscule cancer cells before they develop into tumors and replace damaged cells with miniature biological
machines. With the development of synthetic tissues, organ transplantation will no longer depend on human donors. 'Best guess' will be replaced by evidence-
based decision support at the point of care. Smoking finally will be outlawed and advances in vaccines will lower our risks of cancer and many chronic diseases.
"On the systemic front, Americans will have decided that their first priority in health care is universal access to preventative care, reducing millions of 'last resort'
emergency room visits. The health care industry will have joined the IT revolution that swept all other industries beginning in the late 20th century. ... Money saved
in administrative costs and superfluous or improper treatment will be used to provide millions more people with access to care, freeing up hospital beds for only the
most critically ill and injured. Most practicing physicians will be women, and the nurse's role will expand enormously."
What are the major challenges the industry will face in reaching its goal over the next 25 years? "The most significant challenge is engaging communities and
legislators in the great health care conversation in which we decide exactly what kind of health system we want to propagate through the 21st century. Few people
are satisfied with the system we now have, yet the political will seems absent when it comes to taking the first step -- setting priorities.
"An equally important challenge is determining the cost of engineering change and how we will pay for it. How will universal access to preventative care be
funded? As technology becomes more expensive by the day, who will pay for the systems the industry needs to realize its goal of more efficient communication
and high-quality care with every patient encounter? How can competing stakeholders come together to realize common goals?
Initiatives aimed at needed changes are now under way across the industry involving the federal and state governments, hospitals, physicians, insurers and
employers. But these efforts require central coordination, which has yet to materialize. We desperately need a commitment similar to the Apollo project that
focused the country on a stretch goal."

Read more: Health care 2030: Future changes will be 'stunning' - Phoenix Business Journal