2009-10-30
The U.S.
House of Representatives unveiled HR 3962, the Affordable Health Care for America
Act,
earlier today. The bill represents the melding of the three House versions of
health system reform legislation and includes a public option in which
physician participation is voluntary and payments are based on negotiated rates
and the private insurance market, not Medicare rates.
The House
also unveiled HR
3961, the Medicare Physician Payment Reform Act. This bill would
repeal Medicare's sustainable growth rate, or SGR, formula and replace it with
a payment system that provides for more predictable updates from Medicare. This
bill would eliminate the 21 percent cut planned for 2011 while establishing a more
sustainable physician payment system.
The
Affordable Health Care for America Act aims to provide health insurance of one
form or another to 96 percent of all Americans at an expected cost of just
below $900 billion over 10 years, without increasing the federal budget deficit
for at least 20 years, according to House Democrats. However, Republicans
quickly dismissed the bill as an attempted government takeover of health care
and it is expected that they will offer no support for the measure. Earlier versions of the House bill carried an estimated cost of over 1 trillion
dollars over 10 years. House negotiators lowered the price tag, in part,
by expanding Medicaid coverage to a broader slice of the population and by
separating out the Medicare physician payment fix, which is estimated to cost
$250 billion over 10 years.
In
addition to increasing access to coverage, the Affordable Health Care for
America Act would implement insurance reforms that would ban lifetime limits on
coverage, extend coverage, and protect people from pre-existing condition
exclusions. The bill also includes several provisions to reform the
health-care delivery system by focusing on rewarding high-quality care. This includes:
- Promoting
Accountable Care Organizations – An “Accountable Care Organization” (ACO) is an
organized group of physicians who are rewarded for providing high-quality care
at low cost over a sustained period of time. The bill would establish an
ACO pilot program and would authorize the continued expansion of the program
where it proves successful in improving quality and keeping costs under
control.
- Promoting payment bundling – Hospital and physician incentives would be restructured by
paying a lump sum for an episode of care (bundling payments), rather than
paying separately for each service provided. The bill would establish a
nation-wide pilot program to test the effectiveness of payment bundling in a
wide array of settings.
- Reducing hospital re-admissions – The bill would use new financial incentives to
encourage hospitals and post-acute providers to undertake reforms needed to
reduce preventable re-admissions.
- Promoting
the patient-centered “Medical Home” model – The bill would establish a pilot
program that reimburses providers who give comprehensive care-coordination to
patients with chronic illnesses.
The
House of Representatives is expected to begin debate on both bills the first
week in November. ASH staff will be providing a more thorough analysis of the
bills and update on the House strategy for combining the bills or moving them
separately as more information becomes available.
More
Information About Health Reform
ASH will offer the following special sessions about health reform and its impact on hematology at its annual meeting in New Orleans:
Practice
Forum: New American Health-Care Policy and the Practice of Hematology
December 5, 6:00 – 7:30 p.m., Marriott Convention Center Blaine Kern A/B
The
Practice Forum will address Medicare reimbursement changes in 2010, emerging
health reform policies and how these reforms will affect the practicing
hematologist.
ASH/EHA
Policy Forum: The Cost of Health-Care
December 6, 12:30 – 1:30 p.m., Hall F, Ernest N. Morial Convention Center
Co-sponsored by ASH and the European Hematology Association (EHA), this year’s
Policy Forum will feature noted health economist Paul B. Ginsburg, PhD, President
of the Center for Studying Health System Change, who will discuss the cost of
health-care and balancing a patient’s right to care with the high cost of some
drugs and procedures.
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