October 30, 2009

HEALTHCARE REFORM

House Leadership Releases Merged Healthcare Reform Bill
Yesterday, the House released a healthcare reform bill that merges the bill passed by the three House committees of jurisdiction (Education & Labor, Energy & Commerce, Ways & Means).  The legislation is expected to be considered by the full House next week.

Major provisions of the bill include:
Coverage:

• Expansion of health insurance to an estimated 96 percent of legal US residents under 65
• Individual mandate with penalties
• Employer mandate for those with payrolls over $500,000 with penalty
• Subsidies for low- and middle-income families
• Medicaid expansion for families at or near poverty level

Insurance reform:

• Ban on preexisting conditions exclusions
• Ban on rate adjusting based on preexisting conditions or gender
• Limits on rate adjustment, limited to age and family size
• Public Option with negotiated provider payment rates

Financing:

• $480 billion tax increase for singles $500,000/families $1 million
• $20 billion tax on medical devices
• $400 million in spending cuts (mostly Medicare)

Of specific interest to the ATS, the bill includes:

• Medicare coverage of end-of-life counseling (described as “advance care planning” in the bill)
• SSI eligibility exemption for clinical trials participation compensation  - Improving Access to Clinical Trials
• Expansion of Comparative Effectiveness Research
• Provisions to address healthcare workforce shortages
• Physician payment “sunshine” requirements - but with an exemption for industry- sponsored CME activities
• Expansion of Medicare quality programs
• Expands Medicare and Medicaid beneficiary access to preventive services by eliminating cost-sharing
• Strengthening of the public health infrastructure through creation of a Public Health Investment Fund with authorized funding of $33 billion over 5 years
• Creation of a Prevention and Wellness Trust Fund for community-based prevention and chronic disease management with authorized funding of $34 billion over 10 years.

Medicare SGR Fix
Missing from the bill is a permanent fix to the Medicare sustainable growth rate (SGR) formula.  The earlier versions of the House bills had included a permanent fix to the SGR.  The House leadership has decided to address the SGR fix in separate legislation.  That separate legislation was also introduced yesterday and will likely be considered in the very near future. The ATS, along with the rest of the physician community, is committed to finding a permanent fix to the SGR problem.  We will continue to urge Congress to provide a permanent solution to the SGR problem within the context of healthcare reform.

Next Steps
The House is expected to debate the bill next week with a final vote possible as soon as Friday (but more likely running into the weekend or the following week).  The ATS Washington Office will be in contact with members of the House to articulate our support for key provisions for the bill, including the public option, and our concerns about other the areas of the bill, including consideration of hospital-acquired conditions in quality measures.

Points of Contact