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September 25, 2009


September 25, 2009

Senate Finance Committee Begins Consideration of Health Reform Overhaul

This week, the Senate Finance Committee, chaired by Max Baucus (D-MT), began consideration of health reform overhaul legislation, the America's Healthy Future Act. The legislation includes insurance reforms and an individual mandate to purchase health insurance, along with the creation of health insurance cooperatives and subsidies for low income families to provide health insurance to an estimated 30 million currently uninsured Americans. Following member opening remarks, the committee began work by questioning the Director of the Congressional Budget Office, Douglas Elmendorf, on the bill' s final cost estimates. Elmendorf revealed that the cost estimates may take up to 2 weeks once the bill is finalized, news which disappointed Chairman Baucus. During the four days of deliberation this week, the committee voted on a number of amendments, ranging from the individual insurance purchasing mandate to limits on age rating in insurance premiums, to modifications to the Medicare Advantage program. The ATS sent a letter to all Finance Committee members this week outlining support for amendments relating to respiratory, critical care and sleep medicine. In the letter, the ATS reiterates its support for a public health insurance option as most effective mechanism for expanding insurance coverage and reducing system costs.

Tobacco Use Rating

An issue that the ATS has taken exception to in the Senate Finance Committee bill is insurance rating for tobacco use. The bill would allow insurance premiums to vary based on tobacco use, age and family composition, with tobacco use varying at a ratio of 1.5:1. In the letter to the Finance Committee, the ATS states that tobacco use should be treated like all other addictions. The ATS further points out, "Tobacco use is only one of a number of risky behaviors that impact public health and health care expenditures….Singling out this one risk behavior is unfair." The letter continues, "Patients may also feel compelled to lie to physicians about tobacco use. Hiding tobacco use will complicate clinical diagnosis and frustrate efforts to enroll patients in tobacco cessation programs." The ATS also expressed opposition to an amendment offered by Sen. Ensign (R-NV) that would increase insurance risk adjustment significantly for smokers.

Physician Workforce

The ATS letter urges the committee to adopt amendments to alleviate the pulmonology, critical care and sleep specialist workforce shortages, including an amendment sponsored by Sens. Nelson (D-FL) and Schumer (D-NY) that increases the number of Medicare-funded graduate medical education (GME) training positions by 10,000.

The ATS letter urged action on the following other issues:

  • A permanent fix to the Medicare SGR formula
  • Improved access to home health care
  • Medical liability insurance reform

The Finance Committee dealt with another issue this week that the ATS has become proactive on Medicaid reimbursement of pediatric care. Currently, Medicaid reimburses pediatric providers, including specialty care providers, well below Medicare rates, which leads many pediatric providers to limit their number of Medicaid patients. The ATS is supporting amendments to make Medicaid primary and specialty pediatric reimbursement equitable over time. An amendment from Sen. Grassley that would have increased the Medicaid rates, was voted down by the Finance Committee, due to a required offset that would have cut premium subsidies for middle-income families.

Next Steps in the Process

The Senate Finance Committee is expected to continue consideration of its health reform bill next week. Meanwhile, the House Energy and Commerce Committee, chaired by Rep. Waxman (D-CA), completed work on its health reform bill. House leaders will now work on merging this bill with other versions passed by the Education and Labor and Ways and Means committees.

Clean Air: EPA Issues GHG Emission Rules

The Environmental Protection Agency issued final rules requiring all major sources to publicly report their annual green house gas (GHG) emissions. The rule requires major sources of GHG - defined as emitting the equivalent of 25,000 CO2 equivalent tons - to report their emissions. The EPA rule specifically covers the following GHGs:

  • CO2
  • CH4
  • N2O
  • SF6
  • HFCs
  • PFCs
  • and other fluorinated gases

The EPA estimates that the final rule will capture over 85% of all GHGs emitted in the U.S. It is expected that the rule will better describe the sources of GHG emissions in the U.S. and help policy makers craft policy to reduce total emissions.

The final rule can be viewed at: http://www.epa.gov/climatechange/emissions/ghgrulemaking.html

Tobacco: Candy Flavored Cigarette Ban Takes Effect

A ban on candy flavored cigarettes started in the U.S. this Tuesday, as FDA exercised its authority under the recently passed legislation granting the Food and Drug Administration authority to regulate tobacco products. The legislation expressly banned "candy" flavored cigarettes and established an implementation deadline for establishing a ban.

The candy flavored tobacco ban is the first of many anticipated FDA actions expected to regulate tobacco use in the U.S. The ATS is encouraged by th FDA action and will work with the FDA in developing further policy to regulate - and hopefully reduce - tobacco use in the U.S. and abroad.

For additional information about the ban please visit the FDA website.

Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator