The February 25th bipartisan health care summit concluded without any apparent progress on reaching agreement on a health reform proposal. This lack of progress and the comments from participants following the meeting has led ASA leadership to believe it is increasingly likely that a “reconciliation” strategy will be utilized to attempt to move the President’s reform proposals forward. ASA members are urged to remain vigilant.
ASA had learned that under a strategy contemplated by the White House and House and Senate Democratic leaders, a reconciliation bill would likely be paired with H.R. 3590, the “Patient Protection and Affordable Care Act,” the health reform bill previously passed by the U.S. Senate in a two bill, two track process.
The reconciliation bill, which has yet to be written, would “modify” or “correct” the Senate bill to include the changes proposed by President Obama as part of the summit (proposal below). The bill would then face consideration under special rules in the House and Senate. These rules protect the bill from filibuster; only 51 votes would be needed in the Senate. Both bodies would need to pass the reconciliation bill.
Once the reconciliation bill was passed by both bodies, the House would also consider and pass H.R. 3590. Additional Senate consideration of H.R. 3590 would not be required because the Senate had previously passed the bill on December 24, 2009. Both the reconciliation bill and H.R. 3590 would then be sent to the President for his signature.
ASA remains concerned about both pieces of the reconciliation strategy. Foremost, the contents of the reconciliation bill are not yet known. The bill creates an opportunity for previously defeated or excluded provisions to be restored to the reform proposal. Proposals such as a public option tied to Medicare payment rates could be included in the reconciliation bill as could other provisions that proliferate Medicare payment rates. During this process it will be critical for ASA to continue to work with the Congressional leaders who have thus far shielded our specialty from the devastating effect of expanded use of Medicare’s fee schedule.
ASA also has particular concerns about H.R. 3590. Unlike its House counterpart, the Senate reform bill includes provisions designed to reduce Medicare payments to anesthesiologists and other physicians. The bill also includes scope-of-practice tinged “non-discrimination” language long opposed by ASA and many other medical societies. In fact, these and other provisions in H.R. 3590 resulted in ASA previously urging a “no” vote during the bill’s initial consideration in the Senate in December 2009.
ASA will continue to carefully monitor ongoing reform discussions and we will remain particularly vigilant should a reconciliation bill be crafted. ASA members are strongly urged to monitor the Washington, D.C., portion of the ASA website for additional information and “Calls to Action.”
White House link to President Obama’s Proposal
Summary of President Obama’s Proposal
ASA Letter of Opposition to Senate bill
Surgical Community letter to President Obama on February 19, 2010
White House Letter to Congressional Leadership on March 2, 2010