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Health Care Reform Update From ASA President Alexander A. Hannenberg, M.D.

Chicago — (November 4, 2009) 

Dear Colleagues:

As Congress continues moving full-speed ahead toward enactment of health care reform legislation, it is absolutely essential that ASA members understand the policies, procedures and politics involved.  Because new information and developments emerge from Capitol Hill on a minute-by-minute basis, we want to provide you as many opportunities as possible to stay informed and involved.

I would like to provide you with a brief update about the ever-changing debate.

U.S. House of Representatives

This coming Saturday, the House is tentatively slated to vote on the new H.R. 3962, the “Affordable Health Care for America Act.”  The bill is a significantly modified version of H.R. 3200 previously adopted by the House Ways and Means, Energy and Commerce, and Education and Labor Committees. 

Most notably for ASA, H.R. 3962 includes a public plan that has moved away from payment rates tied to Medicare rates for physician services, and instead provides provisions toward freely negotiated rates.   This significant change has been ASA’s top priority, and ASA members are to be congratulated for their tremendous grassroots efforts urging Congress to reject a public plan tied to Medicare payment rates.

As part of the debate on H.R. 3200, ASA strongly supported a proposed amendment by Eddie Bernice Johnson (D-TX) that would have de-linked a public plan option from Medicare payment rates for anesthesia services.  Now that H.R. 3962 includes negotiated payments allowing anesthesiologists to be paid at commercial/private insurance levels, Rep. Johnson’s amendment is essentially moot.  ASA is extremely grateful to Rep. Johnson for her leadership on this important issue, and to ASA members for their hard work supporting the Johnson amendment.  The support it generated ultimately helped move House leadership away from a public plan tied to Medicare rates.

More universally, the new bill includes a number of important health insurance reforms that would expand access to insurance coverage and ensure broader fairness to patients by health plans. ASA is extremely supportive of these provisions, which include guaranteed issuance, guaranteed renewability, no lifetime or annual limits on care, the elimination of pre-existing condition prohibitions, and other reforms.  H.R. 3962 would also create a health insurance “exchange” through which certain individuals could purchase health plans. 

All told, these health insurance provisions would reduce the percentage of uninsured patients to 4 percent of the population—a tremendous improvement for patients and physicians.

ASA is also pleased that H.R. 3962 would remove the anti-trust exemption for health insurers and add enhanced requirements on insurers to direct more premium resources directly toward patient care and away from excessive executive compensation and investor profits.  This beneficial language would help level the playing field among providers and insurers.

While H.R. 3962 does not include a fix to the Sustainable Growth Rate formula (SGR), House leaders have reiterated their commitment to achieving needed reforms.  They plan to move forward with a new free-standing SGR bill, H.R. 3961, based on the SGR reforms that ASA supported in H.R. 3200.  ASA supports H.R. 3961 to reform the SGR, avoid a 21 percent cut in January 2010, and establish a pathway to future positive Medicare updates.

H.R. 3962 includes thousands of health-related provisions.  Legislation of this magnitude and complexity is not without flaws.  However, I believe it represents a positive step forward in strengthening our health care system without adversely impacting our specialty.

Saturday’s vote, while important, is by no means the end of this process.  We expect many more twists and turns before health care reform legislation eventually becomes law.

U.S. Senate

In the Senate, the Democratic leadership continues to work toward merging proposals crafted by the Senate Finance and Health, Education, Labor and Pensions (HELP) Committees. 

Previously, ASA expressed strong support for provisions included in the Senate Finance proposal that advanced the idea of health care “Consumer Operated and Oriented Plan,” or CO-OPs.    Specifically, ASA was gratified that the proposal would allow for physician payments under the CO-OPs program to be established through independent negotiations between physicians and plans.

Recently, however, it has become apparent that the Senate may seek to target Medicare payments for physician services to finance many of the bill’s reforms.  ASA is extremely concerned that legislation in the U.S. Senate could involve multi-tiered payment cuts for anesthesia and other physician services. 

Specifically, proposals pending in the Senate include the potential for serious physician payment cuts through  four mechanisms: the establishment of “Independent Medicare Advisory Commission” (IMAC), a new entity with the power to implement across-the-board Medicare payment reductions; so-called “resource utilization outlier” provisions that target physicians who are perceived to be using excessive “resources” for patient care without regard for patient acuity or complexity of care required; a new punitive component of the Physician Quality Reporting Initiative (PQRI) that exposes physicians to  payment penalties; and across-the-board payment reductions to support bonus payments to primary care physicians and rural general surgeons.  

While ASA understands the enormous costs associated with health reform legislation of this scale, we believe it is completely unacceptable to finance the legislation with significant Medicare cuts to physicians.  Particularly for anesthesia services—which are paid for by Medicare at a rate of 33 percent of what private insurers pay—it would be outrageous to inflict further payment reductions. 

Looking ahead

We expect an extremely complicated process moving forward with health reform.  After this weekend’s expected vote on H.R. 3962 in the House, the Senate must still agree upon its final package, which could take some time to accomplish.  Once the Senate votes on health reform legislation, it must be merged through a Conference Committee with the bill that the House ultimately passes.

Since the health care debate began earlier this year, ASA has been on the forefront of negotiations—as evidenced by our success in ensuring negotiated rates in the House bill public plan option.  Every day ASA leaders, volunteers and staff are working tirelessly in Washington on behalf of the medical specialty of anesthesiology.  Please be assured that we will continue our efforts in earnest as the legislative process moves forward. 

We welcome your productive questions and feedback.  ASA Washington staff is available to provide additional information, and you are encouraged to call on them for their expertise.  They can be reached at (202) 289-2222. 


Alexander A. Hannenberg, M.D.
ASA President


Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at . To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Like ASA on Facebook , follow ASALifeline on Twitter and follow ASA on LinkedIn .



American Society of Anesthesiologists