Congress made history Sunday with the passage of comprehensive health care reform a century in the making, but today many in Chattanooga, and nationwide, may find themselves pondering the same question.

"Now what?" said Dr. Sally Chu, primary care physician in Fort Ogle-thorpe. "It may be better, might be worse. ... We'll hold our breath and see what comes of it."

The House-passed reconciliation bill, which amends the approved Senate legislation, awaits only the consent of a simple majority in the Senate to become final. But even at the end of more than a year of debate, the ultimate consequences of Sunday's landmark vote still are largely unknown.

Many supporters and critics alike expect the reforms described in the bill will undergo fine-tuning. Some of the legislation's largest reforms won't go into effect until 2014, including a mandate to buy health insurance. Some states, including Georgia, have launched legal challenges to the enforcement of the bill in their boundaries. And the outcome of elections in November and years away could undermine the already-fragile political will to actually enact the reforms promised.

The heavy lifting on health care reform is far from over, said Craig Becker, president and CEO of the Tennessee Hospital Association.

"We all know we're going to have to work hard in the next few years to fix the things we don't like," he said, "but the fact that there will be 32 million additional people with coverage and the insurance reforms are going to come through certainly are good things."

Some who oppose the bill still allow that it will address some very real concerns.

"There is no question that the care of the poor will be improved and the underinsured will no longer face financial ruin if a prolonged illness affects someone in their family," said Chattanooga physician Dr. B.W. Ruffner, president-elect of the Tennessee Medical Association, which has taken a stance against the reform bill.

Still, the impact on the state budget will be tremendous, although it may not be felt for a few years, Dr. Ruffner said in an e-mail.

"When the costs of expanding TennCare begin shifting to the state, either taxes must go up or services must go down," he said.

For some Chattanooga residents, the bill's passage represents a moral victory.

"Health care is a right, not a privilege," said Valerie Epstein, a Chattanooga attorney

"If it turns out doctors aren't fairly compensated (under the reform bill) we can go back and do the tweaking necessary" to improve payments, she said Sunday night.

Dr. Richard Pesce, an intensive care specialist at Memorial Hospital, said he is deeply disappointed by the bill's passage and the effect it could have on the future of the medical profession.

"I suspect that physicians will begin to retire early and that fewer students will select careers in medicine because of the decreased reimbursement over time and the inability to pay back outstanding loans," he said in an e-mail.

Calvin Donelson Elementary School teacher Paul Ruhling, 37, said the approval of health care reform has been a long time coming, and some of the resistance to reform reflects a distorted sense of priorities.

"To date we've spent about $1 trillion in Iraq on a war, and we can't take care of our own. That's kind of a hard one to stomach for me," he said. "I feel like it's those sitting pretty with good health care that don't want change."

AREA REACTION

"It's very disappointing. I do not believe doctors will be able to continue to see patients if the Medicare cuts go into effect." - Melissa Portera, financial manager, Chattanooga Surgical Oncology and Associates

"The pretense that this is 'revenue-neutral' is based on the cost projections of the Congressional Budget Office which grossly underestimated the cost of Medicare. ... Physicians will continue their ethical duty to give their patients the best possible care that government regulations allow." - Dr. B.W. Ruffner, president-elect Tennessee Medical Association

"We need reform but this is not it. ... The future effects of the bill will almost certainly cause hospital closures as Medicare reimbursement rates fall. Taxes will almost certainly go up inhibiting productivity. Some small businesses may benefit with reduced premiums but reduced care will also follow." - Dr. Richard Pesce, intensivist, Memorial Hospital

The vote shows that "we will take care of our fellow Americans. I believe health care is a right, not a privilege." - Valerie Epstein, Chattanooga lawyer

"My concern is (the bill's funding) relies too heavily on Medicare cuts, which are not prudent and not likely. Medicare is not sufficiently funded currently. ... More likely what will happen is they won't enact the Medicare cuts and it will balloon the federal deficit." - Bill Taylor, executive director of Physician Practice Resources

"It is a multibillion-dollar mandate on Tennessee and we do not have the money to pay for it. ... If it's enacted into law, I'm going to help lead the repeal effort. - U.S. Rep. Zach Wamp, R-Tenn.

"(W)e believe that the overall health care reform effort fails to address quality of care and the rising cost of health care in the U.S. Indeed the legislation will exacerbate an increase in health care costs by levying billions in new taxes and assessments that will ultimately be shouldered by individuals, families and employers." - John Sorrow, president of the Mid-South Region for Cigna Healthcare

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