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Special Report on Health Reform

Chicago — (July 24, 2009) 


President Obama has set forth an aggressive agenda for health care reform, reiterating that he would like to sign a bill by October.

Members of the key committees in the House and Senate have affirmed a commitment to completing work on the reform bills in time for the President’s signature in October, and Congress seems to be rapidly moving forward with the aggressive timeline.

Still, there is a long road ahead, and the timeline may ultimately vary from what President Obama and Congress originally planned. Just today Senate Majority Leader Harry Reid (D-NV) announced that the Senate will not vote on health care reform legislation until after they return from a month-long summer recess.

Indeed, much work remains, and many variables still exist.

Process Primer

Before President Obama can sign any health care reform bill into law, these steps must occur:

Key health care committees in the House and Senate must adopt or “report” versions of health care reform legislation. So far, three of the five key committees have reported a bill. Eventually, the committees will send legislation to the House and Senate for full consideration.

Both the House and Senate must pass health care reform bills. Once both chambers pass legislation, they will likely “conference” to reconcile any differences between the House and Senate versions of the bill. After conferencing, the House and Senate must pass identical versions of health care reform legislation.

If both chambers pass the legislation, it can then be sent to President Obama for his signature.

Current status

In the Senate, the Health, Education, Labor and Pensions (HELP) Committee has adopted the “Affordable Health Choices Act,” which has not yet been given a bill number. The Committee approved its health reform bill on July 14, with a 13-10 party-line vote. The bill must now be merged with whatever version emerges from the Senate Finance Committee before it is considered by the full Senate.

The Senate HELP bill includes a public plan option with negotiated rates, rather than a public plan based on Medicare payment rates. However, the final provision remains influx since the HELP committee does not have jurisdiction over Medicare matters.

The Senate Finance Committee, the other Senate committee with jurisdiction over health care issues, is expected to release its version of health care reform legislation in the coming weeks. The Finance Committee version is generally expected to be the most moderate of all reform proposals. Indeed many observers believe that the Finance Committee proposal has the best chance of securing bipartisan support.

In the House, three committees responsible for health care legislation, Energy and Commerce, Ways and Means, and Education and Labor—or the “Tri-Committee”—have introduced H.R. 3200, the “America’s Affordable Health Choices Act.” The bill has been adopted by the Ways and Means Committee and the Education and Labor Committee, and is still under consideration by the Energy and Commerce Committee.

H.R. 3200 currently includes a public plan option based on Medicare rates. ASA members and staff are diligently working with members of the Energy and Commerce Committee to amend the legislation.

Prior to facing consideration by the full House, the three separate versions will have to be merged into a single bill.

Overall, while Congress and President Obama remain committed to an aggressive timeline for reform, several developments signal that the process may be slowing. For example, the Blue Dog Coalition, a group of fiscally conservative Democrats, sent a letter to Energy and Commerce Committee Chairman Henry Waxman (D-CA) outlining their concerns about H.R. 3200 in its current form, and recently held a three-hour meeting with President Obama to discuss their problems with the legislation. The group is threatening to vote against the bill unless major issues are first addressed. Notably, the Blue Dog Coalition is opposed to a public plan option based on Medicare rates. ASA president Roger Moore, M.D., issued a statement applauding the Blue Dog Coalition’s stance.

Key Issues

While the 1,200 page bills include a number of complex health care provisions, several contentious issues have emerged during the health care debate.
  • Individual mandate
  • Employer mandate
  • Financing of the bill’s provisions
  • Medicare physician payments/SGR reform
  • Public option
Summaries of the each of the bill’s key provisions are available at the following links:
ASA's Current Position

ASA recognizes that there are many laudable provisions included in the House and Senate health reform bills, such as insurance reforms including guaranteed issue and renewability, and elimination of preexisting condition exclusions. Still, we believe that many issues remain unresolved, and questions linger about various provisions’ impact on anesthesiology.

In the House, ASA does not support H.R. 3200 in its current form. The bill includes a public plan option based upon Medicare payment rates for anesthesia and all other physician services, which would be detrimental to the medical specialty of anesthesiology. ASA leaders, staff and grassroots are working with key legislators to amend the legislation through the committee process.

Anesthesiologists face a unique Medicare payment problem. GAO, the investigatory arm of Congress, has found that Medicare pays anesthesiologists 33 percent of what private insurers pay for anesthesia services. (Meanwhile, MedPAC reports that Medicare pays an average of 80 percent of what private insurers pay for other medical specialties).

The 33 percent payment level simply does not reflect the costs of providing anesthesiology medical care. ASA is determinedly urging lawmakers to address this problem.

In the Senate, ASA has noted that the HELP bill includes a public plan option with negotiated rates, subject to limitations. While not perfect, this provision represents an important step away from Medicare-based payment rates.

ASA is anticipating the release of a bill from the Senate Finance Committee, and is hopeful that the draft will not include a public plan option based on Medicare’s unsustainably low payment rates for anesthesia services.

Get involved

While ASA is working hard on your behalf, it is absolutely essential that the collective voice of anesthesiology is heard throughout the halls of Congress. We strongly encourage you to contact your Representative and Senators to explain anesthesiology’s unique 33 percent problem under Medicare.

Right now, every ASA member should call his or her Representative to ask that the House amend or revise H.R. 3200 to fix payment levels for anesthesia services provided under the public insurance plan. Since the process is moving quickly, phone calls are much more effective than emails at this point.

For instructions on calling your Representative, as well as anesthesiology-specific talking points, please use the following link:

Other news

ASA has learned that several health care organizations, including the AMA, American College of Surgeons and American College of Physicians, have endorsed H.R. 3200. Because of Medicare’s unique payment system for anesthesia services, ASA cannot and will not support H.R. 3200 in its current form.

ASA President Roger Moore, M.D., released a statement clarifying ASA’s position, in light of other groups’ endorsement.

Similarly, Dr. Moore sent a letter to AMA leadership urging unity in the fight against a Medicare rate-based public plan.

Many other health care organizations either oppose the bill, or are remaining neutral at this time.

Stay informed

Health care developments occur rapid-fire on Capitol Hill. The situation often changes from hour-to-hour. It is absolutely essential to stay up-to-date on the latest happenings in the health care reform debate.

ASA provides a number of resources for its members to stay informed:
  • Bookmark the ASA Health Care Reform webpage
  • Subscribe to ASA’s RSS feed
  • Sign up for the ASA Grassroots Network
  • Join “ASA Grassroots Network” on Facebook
  • Follow @ASAgrassroots on Twitter

Your ASA Washington Office staff is available to answer questions or provide additional information. You can reach the office at (202) 289-2222.


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