Chicago — (October 19, 2009) 

Dear colleagues:

Throughout my presidency I have written to tell you that major health reform is coming. Now, as my term nears its end, I am writing to tell you that health care reform legislation continues to proceed in both the U.S. House and U.S. Senate, as you undoubtedly know from continuous news reports.

The process has been long and tedious, with many twists, turns and bumps along the way. With Congress and the Administration seeking to reform a system that accounts for 16 percent of the U.S. economy, complicated proposals, heightened emotions and constantly-changing ideas are to be expected.

Overall, ASA supports many reforms included in various health care reform packages. Important insurance reforms and a reprieve from the Sustainable Growth Rate formula (SGR) would go a long way toward strengthening America’s health care system. We applaud leaders in Congress for their commitment to enacting meaningful reform, and for seriously considering how different bills will affect patients and the physicians who provide their care.

However, ASA has also conveyed to House and Senate leaders that some constructs in current legislation are completely unacceptable to anesthesiologists. ASA remains gravely concerned about any proposal that would tie a public plan or other new government health care option to Medicare payment rates, and we have been extremely vocal to Congress about our unique payment issues. We continue to monitor legislative developments for any proposals that would unfairly disadvantage the medical specialty of anesthesiology and are actively working to change them.

With continued Congressional consideration of health care reform anticipated over the next few weeks, the following is an overview of where the process currently stands, ASA’s continued involvement, and how you can help.

Overview
Five committees in the U.S. House and Senate have all but completed work on comprehensive health care reform legislation. Now, action shifts to leadership in both chambers. Leaders in the House and Senate will decide the final version of the bill that ultimately goes forward for a final vote in each chamber.

House
The House health care reform bill, H.R. 3200, the "America’s Affordable Health Choices Act," has been adopted by the three committees with health reform jurisdiction: Ways and Means, Energy and Commerce, and Education and Labor. While largely the same, the Committees’ bills do have different provisions. The three versions of the more than 1,000 page bill must be merged to allow a single bill to be sent to the House floor for a vote.

H.R. 3200 includes major health insurance reform provisions: guaranteed issuance, guaranteed renewability, no lifetime or annual limits on care, the elimination of pre-existing condition prohibitions, and other reforms. The bill also would create a health insurance “exchange” through which individuals could access qualified health plans.

Another crucial provision of H.R. 3200 is reform of Medicare’s Sustainable Growth Rate formula (SGR). These provisions are not perfect, but they would be meaningful steps forward—effectively preventing a 21 percent Medicare payment cut scheduled for all physicians beginning Jan. 2010. The provisions would amount to $230 billion in averted cuts to physicians over the next 10 years.

While ASA supports these important and much-needed reforms, we remain adamantly opposed to a new public plan option based on Medicare payment rates, as included in two Committees’ bills. The Ways and Means and Education and Labor committees adopted draft legislation that includes a public plan option tied to Medicare payment rates.

ASA strongly supported the Blue Dog Coalition in its efforts to amend H.R. 3200, the “America’s Affordable Health Choices Act.” The Blue Dogs prevailed on an amendment in the Energy and Commerce Committee that would de-link a public plan option from Medicare payment rates, and would instead allow for negotiated payments.

At the same time, the Congressional Progressive Caucus, a group of liberal House Democrats, has ramped up its efforts to ensure that final legislation does include a Medicare rate-based public plan option.

In the coming days House leaders will work to combine the three proposals into one bill that will ultimately be considered by the full House. The design of a public option remains at the center of this House debate.

Senate
After months of negotiations and efforts to craft a bipartisan bill, Sen. Max Baucus (D-MT), Chairman of the Senate Finance Committee, introduced his version of health reform legislation. The America’s Healthy Future Act contains many of the same provisions as H.R. 3200 related to health insurance reforms.

ASA is extremely pleased that the Finance bill includes negotiated rates as a key feature of proposed health insurance “co-ops,” rather than payments based on Medicare rates.

During the mark-up, the Committee rejected two amendments seeking to add a public plan option to the Finance Committee bill. Sen. Jay Rockefeller (D-WV) offered an amendment that would have created a public plan based on Medicare payment rates; Sen. Chuck Schumer (D-NY) offered an amendment that would have created a public plan with negotiated rates. Though both amendments were defeated, both Senators have indicated that they will continue to push for a public plan in the final Senate bill.

Now that the Senate Finance Committee has completed its mark-up of the legislation, Chairman Baucus has signaled that the Committee will likely vote on the legislation this week.

The other health care committee in the Senate, the Health, Education, Labor and Pensions (HELP) Committee finished its bill this summer. S. 1679, the Affordable Health Choices Act," includes a public plan that is not based on Medicare payment rates.

It appears likely that President Obama will work with Senate leaders to merge the HELP and Senate Finance Committee proposals into one bill. ASA continues working within a broad coalition of medical groups to influence other provisions of concern in the Senate bills.

Merging legislation
Once House and Senate leaders finalize their respective health care reform bills, they must be voted on in each chamber. Then, the House and Senate must work together to reconcile any difference between their bills through a conference committee.

Please be reminded that the issue of a public plan is still not resolved, and remains one of the most contentious issues in the current debate in both Houses. Each body is expected to take up legislation in October, possibly during the week of the 2009 ASA Annual Meeting.

Take action
For the thousands of you who have taken action by calling, emailing or meeting with your Representative and Senators, I commend you for your dedication to the future of our specialty. Because of your efforts, our message is being heard on Capitol Hill.

For those of you who have perhaps been waiting, be prepared to take up the mantle and do your part in the current debate. No one else is advocating for the issues that are unique to our specialty. Please join the ASA Grassroots Network, and use CapWiz to contact your Members of Congress.

ASA’s continued efforts
Though challenges have abounded, it has been a distinct privilege to serve as ASA president during this time of monumental health care reform. Please be assured that ASA leaders, volunteers and staff remain committed to ensuring that anesthesiology’s voice is heard and heeded on Capitol Hill. Together, we can accomplish truly meaningful reform for our specialty and our patients.

Sincerely,

Roger A. Moore, M.D.
President



UPDATE: Senate Finance Committee passes health reform legislation

The Senate Finance Committee on Oct. 13. reported out comprehensive health care reform legislation, the “America’s Healthy Future Act,” by a vote of 14 to 9. Senator Olympia Snowe (R‐ME) joined with all Democratic members of the Committee in voting to approve the bill and move it out of Committee.

The bill includes major health insurance reform provisions: guaranteed issuance, guaranteed renewability, the elimination of pre‐existing condition prohibitions, and other reforms. The bill also would create a health insurance “exchange” through which individuals could access qualified health plans.

There are provisions included in the proposal that will require continued scrutiny by the ASA. However, ASA is pleased that the Finance bill includes negotiated rates as a key feature of proposed health insurance “co‐ops,” rather than payments based on Medicare rates.

America’s Health Future Act also includes limited, one‐year reform of Medicare’s Sustainable Growth Rate formula (SGR). These provisions would prevent a 21 percent Medicare payment cut scheduled for all physicians beginning Jan. 2010.

Now, Committee Chairman Max Baucus (D‐MT) must merge his legislation with a bill adopted by the Senate Health, Education, Labor and Pensions (HELP) Committee. The full Senate could consider the bill within the next two weeks.

ASA will provide additional information as the legislative process moves forward.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists Web site at www.asahq.org. For patient information, visit LifeLineToModernMedicine.com

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