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February 3, 2012


Washington Letter
February 3, 2012
Newsletter of the American Thoracic Society's Washington Office

1150 18th Street NW
Suite 300
Washington, D.C. 20036
Telephone:(202) 296-9770

Conference Committee Discusses SGR Fix

This week, members from the House and Senate meet for the third time to discuss a compromise bill to forestall the March 1st 27.4 percent cut in Medicare physician payments, tax extenders and unemployment insurance extension.  While Congress has expressed bipartisan support for preventing the immediate cuts and developing a permanent solution to the SGR formula, neither party has a clear idea on where to find the nearly $300 billion needed to pay for a permanent fix.

The physician community is encouraging Congress to commit unused Overseas Contingency Operational funds (unspent Iraq funds) to pay for a permanent fix of the SGR formula.  It is unclear if the members of House/Senate conference committee will use these funds for the SGR fix.

The American Thoracic Society continues to pressure Congress to act now to develop a permanent fix to the SGR crisis.


Conferees Discuss EPA Boiler Rule Delay

In addition to dealing with large issues like how to pay for the SGR fix, unemployment insurance benefits, and payroll tax reductions, the House/Senate conference committee is also bogged down in debating environmental riders that some members want included in the legislative package.  The House Republicans are pushing for an environmental rider that will block EPA rules aimed at reducing air pollution emissions from industrial boilers. 

ATS Urges Congress to Reject Environmental Riders

In response to the Boiler Rule legislative riders and also in anticipation of likely future attempts to insert environmental riders into “must pass” legislation, the ATS joined several other medical organizations in a letter urging Congress to reject any legislative riders that would block, delay or weaken EPA Clean Air Act rules. The letter underscores the health and economic benefits of improved air quality.


ATS Calls for Stronger Health Benefit Standards and Tobacco Cessation Benefits

This week, the ATS wrote to the Secretary of Health and Human Services calling for a stronger and more specific set of essential health benefits (EHB) for consumers purchasing coverage in health insurance exchanges. The ATS letter is in response to a bulletin issued by the department setting out guidance for the EHB standards. The guidance indicates that rather than a prescriptive package of services that must be provided, individual states may determine health benefits that insurers must cover. States will choose from one of the following existing health plans to set a benchmark for items and services included in the essential health benefits package:

  • One of the three largest small group plans in the state;
  • One of the three largest state employee health plans; 
  • One of the three largest federal employee health plan options;
  • The largest HMO plan offered in the state’s commercial market.  

In the letter, the ATS expresses concern that the state benchmark options outlined above have a large degree of variability in covered benefits that may permit some states  to set inadequate benchmark standards that do not include the full range of health care services that patients need access to, such as full access to specialty care, sleep medicine, tobacco cessation services, and preventive services. ATS President Nicholas S. Hill, MD, said, “We urge [the department] to narrow the options for state benchmark plans in order to promote a consistent EHB package and, additionally, to set the minimum benefit standard for services not covered by the EHB, such as diagnosis and treatment of sleep disorders, at the benefit level provided by Medicaid and Medicare.”

The ATS also called for a specified benefit for tobacco cessation services, pointing out that the EHB package will set coverage standards for Medicaid beneficiaries and the currently uninsured, two populations that smoke at much higher rates (30.5 percent and 32.1 percent, respectively) than the privately insured. The ATS also called for a specified benefit for at-home care for patients with chronic diseases and for the department to ensure that cost-sharing in the form of co-pays and deductibles for services, particularly those critical to public health protection, such as tuberculosis diagnosis and treatment, do not create affordability barriers for patients.



The Washington Letter is written by the American Thoracic Society government relations office and emailed to all ATS members living in the United States. The letter keeps clinicians, scientists, and patients abreast of legislative, judicial, and regulatory issues in pulmonary, critical care, and sleep medicine. Each week's edition is archived on the ATS Web site, www.thoracic.org. If you have any questions or one more information about becoming involved in advocacy, please contact the ATS Washington office at 202-296-9770.