2009-08-03
The U.S. House of Representatives has adjourned for its August recess, but lawmakers working on a health-care overhaul still have a lot of work to do over the break to prepare to pass legislation when they return.
Democratic leaders and committee heads will have to find a way to resolve differences in the versions of the bill (HR 3200) approved by two committees — Education and Labor and Ways and Means — and a compromise measure approved, 31-28, late July 31 by the Energy and Commerce Committee that includes proposals crafted with moderate Democrats on the panel who had opposed the original bill over cost concerns.
The House is looking now to pass the bill in mid-September, a few days after Congress reconvenes. Democratic leaders will have to decide over the recess what to do about key concessions Energy and Commerce Chairman Henry A. Waxman (D-CA) made to fiscally conservative "Blue Dog" Democrats to get the bill passed by his committee; consequently, that bill differs significantly from the other two bills.
The differences in the packages are enough to have caused a rift between two groups of Democrats, the Blue Dog Coalition and the liberal Congressional Progressive Caucus. The Blue Dogs have threatened to vote against the original version of the bill, but Progressives are upset by many of the compromises, such as a lesser role for a new government-run "public plan" in negotiating prices and a reduction in subsidies to help people buy insurance.
A fourth congressional committee, the Rules Committee, will now work to combine the three bills, resolve differences, create the bill’s final version, and will adopt the procedure for floor debate, known as the rule.
Meanwhile, progress in the U.S. Senate has been far harder to achieve. A bipartisan group of six senators, led by Finance Chairman Max Baucus (D-MT) has been meeting almost daily for weeks to produce the framework for a bill, but has reached little agreement. They will continue their sessions this week, before the Senate recesses, but the meetings became briefly strained last week as Republicans in the group felt they were being pressured to produce something before they were ready.
The group has set a September 15 deadline for having a proposal to present to the full Finance Committee. Majority Leader Harry Reid (D-NV) hopes to merge the Finance measure with a bill approved by the Senate Health, Education, Labor, and Pensions (HELP) Committee. The HELP panel approved its bill on a party-line vote on July 15.
Regarding physician payment, final health reform legislation has the potential to significantly alter the future structure of Medicare physician payment. The House bill would permanently reform the formula that annually updates reimbursement rates for physician services in Medicare. The revised formula recognizes the importance of primary care by allowing these services to grow at a higher rate than other services, and does not reduce physician pay rates for increases in spending on drugs or lab services. The policy also encourages physicians to form Accountable Care Organizations by providing these organizations with their own targets and update factors. Updates payment rates by the Medicare Economic Index in 2010 as these reforms are implemented.
A permanent fix to the flawed payment formula has been estimated to cost $245 billion over 10 years. The long-term solution proposed by House Democrats has stirred controversy, 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. It remains unclear how the Senate Finance Committee will address physician payment and whether, because of the high price tag, they will now propose a temporary physician fix rather than permanent payment reform.
As health reform legislation evolves, ASH will continue to monitor developments 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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