2009-07-22
Members of the House and Senate continue to wrangle over the specifics of proposed health-care reform legislation. In the House, the “Tri-Committee” bill developed by the Committees on Education and Labor, Ways and Means, and Energy and Commerce is now being marked up by committee members in preparation for a possible floor vote. In the Senate, the Committee on Health, Education, Labor and Pensions (HELP) has passed its version of reform legislation; however, critical cost issues depend on a bill being drafted in the Senate Finance Committee. President Obama has stated repeatedly that he wants to see reform legislation passed by both chambers before Congress recesses for the month of August. The White House has been less forceful about this time table in recent days, and it is unclear whether Congress will be able to pass a bill in that timeframe, but pressure to do so remains intense.
Final legislation has the potential to significantly alter the future structure of physician payment. This week, House Democrats indicated that they are considering adding $245 billion over ten years in order to fix the flawed sustainable growth rate (SGR) that governs physician payments under Medicare. Under this formula, adequate physician payment in recent years has depended on Congress passing short-term “patches” on a nearly annual basis. The long-term solution proposed by Democrats has stirred controversy, though, as its cost would not be offset by other revenue or cost-saving mechanisms elsewhere in the legislation. The Obama Administration has claimed that the $245 billion had been included in its long-term budget projections anyway, and therefore should not be considered an extra cost of health reform, but Republicans, some fiscally-conservative Democrats, and the Congressional Budget Office have not taken this explanation to be adequate.
Also gaining attention this week are House and Senate proposals to create an advisory board with the power to influence payment rates under Medicare. The board would be similar to the current Medicare Payment Advisory Commission (MedPAC) that currently makes recommendations on Medicare payment rates, but it would exist in the executive branch and have much greater power to make policy. Currently, MedPAC’s recommendations are often ignored by Congress. The proposed body would have the power to change Medicare reimbursement unilaterally unless Congress specifically rejects its recommendations. This week, President Obama endorsed this idea in a proposal made by Senator John D. Rockerfeller IV (D-WV), and a similar deal is seen by many as key to bringing fiscally conservative House Democrats on board with a final reform bill.
Health-care reform legislation continues to evolve very quickly. ASH is closely monitoring all these initiatives as they relate to hematologists and will keep members apprised as the bills move forward. Below are links to additional information concerning health care reform:
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