WASHINGTON – Even before his election in November 2008, President Barack Obama was calling for healthcare reform in 2009.

But while Congress made great strides toward completing healthcare reform legislation, by late November it looked doubtful a bill would pass before the end of the year.

The foundation for reform was laid in early 2009 when five congressional committees with jurisdiction over healthcare began drafting their various bills.

The House passed three bills out of its committees and combined them into one bill by July 21.

The 1,990-page Affordable Health Care for America Act (H.R. 3962) – passed Nov. 7 by a slim margin – carries a $1 trillion price tag spread over 10 years that its sponsors say is fully funded and will not add to the national debt.

According to President Obama, the House bill would provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of healthcare for families, businesses, and the government while strengthening the financial health of Medicare.

The bill includes a public health insurance option and measures to reform the private health insurance industry.

The American Medical Association and the Medical Group Management Association supported the bill, though they urged Congress to quickly pass a companion bill to “fix” a broken Medicare payment system for physicians, who face a 21.2 percent cut beginning Jan. 1, 2010.

The Senate has had a rougher go of it.

Some Democrats in the Senate have been skeptical of the mainstream Democratic ideas for reform. The cost of a proposed bill and a public health insurance option for those who don’t have employer-based care have been some of the key sticking points.

Senate Finance Committee Chairman Max Baucus (D-Mont.) introduced America’s Healthy Future Act of 2009 on Sept. 16, with 150 revisions to follow, and a Congressional Budget Office cost estimate of $829 billion.

After prolonged debate, the Senate Finance Committee passed its bill Oct. 13 and combined it with the Senate Health, Education, Labor and Pensions (HELP) Committee’s Affordable Health Choices Act, passed July 16.

Senate Majority Leader Harry Reid (D-Nev.) presented the $848 billion Senate healthcare bill on Nov.18. The nonpartisan Congressional Budget Office determined that the Senate bill would cut federal deficits by $130 billion over the next decade, the biggest cost savings of any healthcare reform legislation to come before Congress this year.

According to the CBO, the amended Senate Finance Committee bill includes a measure which, like the House bill, would establish a mandate for most legal U.S. residents to obtain health insurance. It would also create insurance “exchanges” as an alternative to a public option. It would significantly expand eligibility for Medicaid and would impose a 40 percent excise tax on insurance plans with premiums above $8,500 for individuals and $23,000 for families.

There was much uncertainty in late November whether the bill would be ready for a floor vote before the end of the year.

If and when the Senate passes this bill – there will be one final battle as Congress works to combine the House and Senate versions into one bill for a vote.

This August saw a host of hostile town hall debates over healthcare, where strong emotions for both sides brought health reform to the forefront. The U.S. has not seen this magnitude of a healthcare debate since 1965, when after 30 years of wrangling, Congress passed Medicare into law as part of the Social Security Amendments.

Perhaps Congress will make history again, almost 45 years later.