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September 1996
Volume 60 |
Number 9
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WASHINGTON REPORT
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| Congress Passes
Insurance Portability Legislation |
Michael Scott, Director
Governmental and Legal Affairs
E-mail the author
An agreement in late July between Rep. Bill Archer (R-TX) and
Sen. Edward M. Kennedy (D-MA) on provisions of the bill relating
to medical savings accounts (MSAs) cleared the way for appointment
of conferees on the long-stalled insurance portability legislation
and ultimate passage of the bill in early August by both houses.
President Clinton is expected to sign the bill promptly.
Members of both parties claimed credit for the bill. The portability
provisions were essentially drawn from the President's health
reform proposal of two years ago, which died in the face of savage
opposition by the insurance industry and represented a major factor
in the GOP gaining control of the Congress last year.
Congressional Republicans, on the other hand, emphasized their
ability to work out portability terms acceptable to the insurance
industry and to business interests. Principal architects of the
legislation were Sens. Kennedy and Nancy Kassebaum (R-KS), Chair
of the Senate Labor and Human Resources Committee, who is retiring
this year.
The principal impediment to earlier passage of the legislation
was the insistence of House Republicans that at least an experimental
program for MSAs be included. An effort by Sen. Robert Dole, prior
to his retirement from the Senate on June 11, to include an MSA
provision in the Senate version had been narrowly defeated, which
bore heavily on the controversy over appointment of Senate conferees
when Democrats claimed he planned to "stack" the conference
with pro-MSA senators. The Archer-Kennedy negotiations resulted
in the development of a compromise four-year experiment involving
not more than 750,000 employees of small firms or self-employed
individuals.
Of major interest to ASA members, the final legislation contains
language advocated by organized medicine, including ASA, that
addresses fraud and abuse, requiring that a provider act "knowingly
and willfully" before criminal sanctions could be imposed
and that the government provide binding advisory opinions on fraud
and abuse issues when advice is requested by a provider.
Practice Expense Extension Introduced in House
During the latter half of July, the ASA Washington Office was
active in generating support for H.R. 3859, introduced by Reps.
Edward Whitfield (R-KY) and Ralph M. Hall (D-TX), the effect of
which would be to extend the effective date for implementing new
resource-based practice expense values under the Medicare Fee
Schedule by one year, to January 1, 1999.
Impetus for the proposed legislation was the Health Care Financing
Administration (HCFA) announcement that it had fallen behind in
surveying indirect physician practice costs and that "proxy"
data would be used in-stead in preparing a proposed schedule of
practice expense values for public review and comment next spring.
Along with several other members of the Practice Expense Coalition,
ASA successfully lobbied the AMA House of Delegates to adopt a
resolution favoring delay in the practice ex-pense implementation
date. Since then, ASA legislative representatives and key contacts
have been in touch with numerous congressional offices, seeking
sponsors for the bill. The only apparent vehicle for the proposal
in the present Congress is believed to be the omnibus Continuing
Resolution for FY 1997, expected to be considered in September
prior to recess for the elections.
Patent Bill Passes House
By more than a 2-to-1 margin, the House adopted on July 24 an
amendment to one of the FY 1997 appropriations bills that would
forbid the Patent and Trademark Office from using funds for the
issuance of medical process patents.
The amendment, originally introduced in slightly different form
by Rep. Greg Ganske (R-IA) as H.R. 1127, had received strong support
from the medical community, including ASA, in the wake of recently
settled patent infringement litigation relating to an ophthalmic
surgical procedure.
The Ganske amendment was vigorously opposed by the biotechnology
industry, which was concerned about the impact of the ban on the
patentability of biotechnological processes such as gene therapy.
Although somewhat appeased by last-minute revisions to the amendment
designed to protect the industry, biotechnological company spokespeople
still objected to the form of the bill, expressing preference
for the concept of a similar bill (S. 1334) introduced last year
in the Senate by Sen. Bill Frist (R-TN). Negotiations concerning
the terms of the Frist bill had stalled in recent weeks, and it
is hoped that House passage of the Ganske version would give impetus
to further discussions.
Both Sen. Frist and Rep. Ganske practiced surgery prior to their
election in late 1994.
Commerce Committee Reports Gag Clause Ban
On the same day the House adopted his patent bill, Rep. Ganske
succeeded in gaining unanimous House Commerce Committee approval
of his bill (H.R. 2976) prohibiting managed care organizations
from placing limits on communications (so-called "gag rules")
between providers and their patients. The bill, expected to be
brought to the House floor in September, received strong support
from the Patient Access to Specialty Care Coalition, in which
ASA is an active participant.
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