November 20, 2009

Healthcare Reform: Senate Leadership Unveils Healthcare Reform Overhaul

This week, Senate Majority Leader Reid released the final version of the Patient Protection and Affordable Care Act for consideration on the Senate floor. If passed, the legislation—which would cost $849 billion—would reduce the deficit by $127 billion over a decade and extend health insurance coverage to 31 million uninsured Americans (or about 94 percent of the population). It would also establish a health insurance exchange, where people can purchase coverage with federal subsidies, expand Medicaid up to 133 percent of the federal poverty level, and create a public insurance option, with an opt-out option for states.

The Senate bill does not include a permanent fix to the Medicare sustainable growth rate formula, but instead provides a one-year fix. This is one of the ATS’s key issues within the healthcare reform debate and we will continue to work to ensure that the Senate enacts a permanent SGR fix this year. The Senate bill also does not include Medicare coverage of end-of-life counseling. This provision is included in the House version of the legislation and the ATS will continue to lobby that this be included in final legislation.

The Senate bill includes two new measures that the ATS supports: the Independence at Home Act, which creates a new demonstration program to provide coordinated home healthcare services for certain Medicare beneficiaries, and a new pediatric specialty loan repayment program.

The Independence at Home Act was reviewed by the ATS Health Policy Committee and has been endorsed by the ATS as an effective measure for expanding home healthcare services for patients with chronic diseases and reducing system costs. The loan repayment program is open to all pediatric specialties and will help to reduce the national shortage of pediatric pulmonologists.

Next Steps

The legislation released by Sen. Reid is a merger of the bills respectively passed by the Senate Finance Committee and the HELP Committee. The next step is a procedural vote to begin Senate floor consideration, which is expected to come this weekend. Senate leaders have indicated that they have the 60 votes needed to support the motion.

The Senate is expected to debate the bill and vote on various amendments for three to four weeks. The House, on the other hand, passed its version of a healthcare reform overhaul on November 7. It is unclear how the House and Senate versions will be reconciled, but this is not expected to happen before
Congress’s end-of-the-year adjournment

ATS Focus

Although the ATS may comment on a range of issues that come during Senate floor debate, we will focus our efforts on the following:

• Pressing for a permanent SGR fix;
• Supporting the public insurance option;
• Supporting flexibility in consideration of hospital acquired infections in quality reporting;
• Healthcare workforce policy; and
• Supporting prevention and public health programs.

Clinical Practice: House Passes SGR Legislation

This week, the House of Representative passed legislation to permanently fix the Medicare sustainable growth rate (SGR) formula by a vote of 243 -183. The bill would replace the current SGR formula with a new payment formula that:

• Eliminates all SGR debt accumulated after years of temporary, unfunded fixes; and
• Replaces the SGR with two more generous targets of GDP+ two percent for evaluation and management services and GDP + one percent for all other services.

The SGR formula has led to a series of projected cuts in Medicare physician reimbursement. In 2010, the SGR formula will cause Medicare physician payment to be cut by 21.5 percent, unless Congress intervenes.

Attention now turns to the Senate. Earlier this year, the Senate failed to secure the 60 votes necessary to move toward considering a similar bill.

Clean Air: EPA Propose SO2 NAAQS

This week, the Environmental Protection Agency proposed new National Ambient Air Quality Standards (NAAQQS) for SO2, which would replace the current 24-hour average standard of 140 ppb and the average annual standard of 30 ppb.

The ATS supports the EPA’s proposed new standard of 50-100 ppb for one hour. Once the new rule has been published in the federal register—which will likely happen in the next two weeks—there will be a 60-day public comment period. The EPA will also hold a public hearing on its proposal in Atlanta on January 5, 2010.

Tuberculosis: Sen. Brown Urges Administration to Prioritize TB

Sen. Sherrod Brown (D-OH) has written a letter to President Obama urging him to make tuberculosis a priority in the administration’s new Global Health Initiative (GHI). The Obama administration announced the six-year GHI in May 2009, but has not yet unveiled details.

In his letter, Sen. Brown stated that, “in many cases, AIDS patients receiving drugs thanks to American aid die for lack of TB treatment.” He also noted that the role an aggressive U.S. TB strategy could have in shoring up key American allies and in strengthening maternal health, which are two of GHI’s priorities. “Global aid for TB control and prevention will also advance women’s rights, which I know is a priority for your administration,” Sen. Brown wrote. “TB is the leading curable infectious killer of women, claiming even more women’s lives than maternal mortality.”

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Points of Contact

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