The President’s signing on March 30 of H.R. 4872, the “Health Care and Education Affordability Reconciliation Act of 2010,” also known as the “Reconciliation” piece of the health reform package, has ended the first phase of Obama Administration and Congressional efforts to reform health care in the United States. With the signing of H.R. 4872 and the earlier enactment of H.R. 3950, the “Patient Protection and Affordable Care Act (PPACA),” health reform as we know it is now law. ASA is responding accordingly.
At my direction, our Washington, D.C., office undertook and recently completed a preliminary review of H.R. 4872 and 3590. The resulting “ASA Post-Reform Key Issues ‘Watch’ List” catalogues key provisions of the new law that will require continued scrutiny, action and involvement by ASA and others in the medical community. The document will also serve as a starting point in ASA’s effort to respond legislatively to various onerous provisions of the law. Indeed, ASA has already begun outreach to key Members of Congress to begin discussions regarding changes to specific provisions of the bill. And opponents of the bill have already mobilized with proposals for changes to the law as well. Perhaps not surprisingly, even many of health system reform’s strongest supporters recognize the package enacted is far from perfect. As an example, Congressman Pete Stark (D-CA), Chairman of the Health Subcommittee of the powerful Ways and Means Committee, has already announced his intentions to try to change provisions related to the Independent Payment Advisory Board (IPAB). While those changes do not go far enough in our view, Rep. Stark’s statement represents an important affirmation that while the reform bills are law, the legislating associated with reform is far from over.
I can also report that our D.C. team has begun to collect information regarding the process related to the regulatory or rulemaking process that will accompany the implementation of this new law over the next several years. Most of the provisions of the reform law will require the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) or other federal agencies to write rules to assure appropriate implementation of the law’s provision or new programs. In fact, many observers believe that the rulemaking process necessary to implement this new law could be one of the most significant, longest and complicated regulatory undertakings in recent history. This massive process offers both risks and opportunities for our specialty. Much work will need to be done on this area and we are preparing to meet the challenge.
Finally, let me also report that I continue to hear from many ASA members ready to act in response to the new law. I am extraordinarily gratified that so many ASA members have embraced this time of great anxiety and concern as a personal “Call to Action.” The help of all ASA members will be required in this effort. I anticipate many legislative attempts to repeal or revise some or all of this law. I also anticipate a need for our members to respond to the massive rule making process through the formal public comment opportunities. Our voices will need to be heard. Our specialty must continue to be engaged in assuring positive outcomes both on the legislative and regulatory fronts. As we demonstrated with our leadership in the medical community in opposing and stopping the proliferation of Medicare payment rates to other payers, our voices can and do make a difference. Our overarching goal is to ensure that remedies to the shortcomings of American health care strengthen, not threaten, the medical specialty of anesthesiology.
Please continue to monitor the ASA website and your email for additional information about the implementation of this legislation and future ASA “Calls to Action.”
ASA “Watch” list of Key Issues on health reform
Comments of Rep. Stark on IPAB (03-21-2010)
Health Insurance Reform Implementation Timetable
PPACA with Reconciliation Changes Incorporated