2009-11-09

After months of highly contested debate, the U.S. House of Representatives passed legislation, the “Affordable Health Care for America Act” (HR 3962) to overhaul the nation’s health-care system by a vote of 220 to 215. Legislation to correct the Medicare physician payment formula and avert the 21 percent cut in Medicare fees scheduled for January 1, 2010 was separated out of the health reform bill, but is scheduled to be debated and voted on by the House during the week of November 16. All physicians are urged to take action and contact their Representative to support a physician payment fix.

The Affordable Health Care for America Act

The “Affordable Health Care for America Act” (HR 3962) would extend health insurance coverage to millions of Americans who currently lack it. The bill represents the melding of the three House Committee versions of health-care reform legislation. Its passage reflects some political concessions by the Democratic leadership as well as a preliminary round win for President Obama in what could still be a long battle for his top domestic priority.

To obtain the 218 votes necessary for passage, President Obama went to Capitol Hill to make a final pitch for the bill. Speaker Nancy Pelosi (D-CA) and her leadership team were forced to permit lawmakers opposed to abortion rights, led by Representative Bart Stupak (D-MI), to offer an amendment that essentially would extend an existing ban on federal funding for abortions to the health reform bill to earn the support of conservative Democrats. Despite these efforts, 39 Democrats still voted against the bill and only one Republican, Representative Anh “Joseph” Cao (R-LA) voted for it.

Some of the key provisions in the House bill include:

• An individual mandate that would require people to purchase health insurance.
• An employer mandate that would require companies to cover their employees, though small businesses would be exempted.
• Funding to create insurance exchanges to serve people who do not have employer coverage.
• A government insurance “public” option to compete with private plans on the exchange.
• Subsidies to help households earning up to $88,000 in annual income for a family of four to purchase coverage.
• A sweeping Medicaid expansion that would provide free health-care to all Americans with incomes below 150 percent of the federal poverty level.
• Up to $400 billion in Medicare and Medicaid cuts, including to Medicare Advantage managed-care plans.
• A surcharge on taxpayers who earn more than $500,000 a year or $1 million a year for families.
• Insurance reforms, such as bans on lifetime caps, premium disparity based on health status and sex, and coverage denials based on pre-existing conditions.

The bill also includes several provisions to reform the health-care delivery system by focusing on rewarding high-quality care, rather than volume. 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 Congressional Budget Office (CBO) estimates that the gross cost of the bill would be almost $1.1 trillion through fiscal 2019, but the net cost, after taxes, fees and penalties are taken into account, would be $894 billion. As a result of tax provisions and spending reduction included in the bill, CBO estimates that it would actually reduce the deficit by $104 billion.

Take Action to Support the “Medicare Physician Payment Reform Act” (HR 3961)

The House health care reform bill did not include provisions to change the way Medicare reimburses physicians. However, the House plans to debate and vote on the “Medicare Physician Payment Reform Act" (HR 3961) the week of November 16. HR 3961 would block the 21 percent reduction in the Medicare payment rates for physician services scheduled for January, 2010. It would instead provide for an increase in those payments based on the Medicare economic index. 

The fee cut scheduled for January is a result of cost-control provisions, known as the sustainable growth rate that was enacted in the Balanced Budget Act of 1997. Congress has acted repeatedly since 2002 to prevent physician payment cuts by passing short-term “fixes” to the program. The most recent of those measures was enacted in 2008.

In addition to the one year “fix,” HR 3961 would restructure the Medicare physician payment formula on a long-term basis beginning in 2011, taking into account spending since 2009 or, beginning in 2014, spending for the previous five years. It would provide two separate updates, one for evaluation, management, and preventive services and another for other services.

It is critical that all Members of Congress hear from their physician constitutes the need to support HR 3961. To contact your Representative, please visit the ASH Advocacy Center.

Next Steps for Health-Care Reform

Several significant legislative and political hurdles must be overcome before President Obama will be able to sign a health reform bill into law. First, the U.S. Senate must pass a bill; then, the House and Senate must reach agreement in conference and that must be passed by each chamber. At this point it is not clear if the Senate has the votes to pass its version before Christmas – let alone reach agreement with the House in conference. If the Senate acts, negotiations to iron out different between the two chambers could be difficult. Among the toughest issues: whether the public option should include an “opt out” clause for states; whether to require employers to provide coverage to their workers; and whether to tax the rich or tax high-cost health-care policies – a provision economists call the most important in the legislation for reigning in costs. In addition, the abortion issue is likely to fuel even more controversy.

ASH will continue to provide updates on health reform on its Web site. In addition, the ASH Practice Forum during the ASH Annual Meeting will focus on the latest developments in health reform and what they will mean for hematology. 

ASH Practice Forum: New American Health-Care Policy and the Practice of Hematology
Saturday, 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. Be sure to join your colleagues at the networking reception that follows the event.

Speakers:

• Lawrence A. Solberg Jr., M.D., Ph.D., Mayo Clinic
  Overview of Health Care Reform Impact on Hematology
• Robert Berenson M.D., The Urban Institute
  Health Payment Reform Issues and Their Impact on Hematology
• Dr. Peter Greenberg M.D., Stanford University Cancer Center
  Myelodysplastic Syndromes: An Illustration of the Impact of Drug Treatment Costs on the Patient.

A special reception for practitioners will follow. Beverages and hors d'oevres will be provided. The reception will take place in Blaine Kern E/F.

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