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ASA NEWSLETTER
 
 
November 2002
Volume 66
Number 11



Several Health Bills Become ‘Road-Kills’ as 107th Congress Winds Down

As this column is written in early October, partisan differences and election-season politics appear to have spelled legislative “toast” for a number of health-related bills widely supported by organized medicine. Perhaps the only good news is that the prospect for a positive Medicare physician reimbursement update is still alive, though the vital signs are unstable.

Principal among the roadside casualties on Capitol Hill are the patient protection, antitrust relief, professional liability and patient safety bills.

Although both the House and Senate last year passed similar patient protection bills (S. 889, H.R. 2315), advocates for the respective versions have been unable to resolve their differences over sanctions against managed care organizations found to have improperly denied care.

Legislation providing physicians with modest antitrust relief (H.R. 3897) gained sponsorship from 59 House members, but the bill was never marked up in the Judiciary Committee and was never introduced in the Senate.

H.R. 4600, modeled after the successful California statute, the Medical Injury Compensation Reform Act, and containing significant limitations on professional liability exposure, passed the House in September by a comfortable margin but was acknowledged to be dead on arrival in the Senate.

Representative Nancy L. Johnson’s (R-CT) patient safety bill (H.R. 4889), under which private organizations such as ASA could collect non-discoverable medical error data from providers, is expected to pass the House this month. Companion legislation is not expected to move in the Senate (S. 2590), and in early October, Senator Edward M. Kennedy (D-MA) introduced a competing Democratic bill (S. 3029).

In summary, only Medicare “modernization” proposals remain on the congressional radar screens. As previously noted in this column, the House last June passed its version of the bill, H.R. 4954, including both a modest Medicare prescription drug benefit as well as reimbursement relief for Medicare providers. For physicians – whose Medicare conversion factor will drop another 4.4 percent on January 1 unless Congress acts – the House bill contemplates a statutory increase of 2 percent in 2003, followed by estimated increases of 2-4 percent in each of the next two years. The bill also includes regulatory relief provisions adopted from H.R. 3391, a bill broadly supported by medical associations, including ASA.

In the Senate, nothing was essentially done on the provider issue while Senators tilted over the terms of a more generous drug benefit, with sponsors of four different bills eventually failing to garner the necessary votes for passage of any of them. In mid-September, Senators Max Baucus (D-MT) and Charles E. Grassley (R-IA), Chairman and Ranking Minority Member of the Finance Committee, began serious work on a stand-alone provider package; this work resulted in development of S. 3018, which they introduced in early October. Provisions in the bill for a physician update are essentially identical to those in the House bill.

That’s the good news. The bad news is that S. 3018 contains virtually everything on every Senator’s Medicare wish list, driving the 10-year cost of the legislation to at least $43 billion and maybe more. That figure is about $20 billion to $25 billion more than the White House has made clear it is prepared to spend, and many observers believe that the bill died about 10 minutes after it was introduced. Further complicating the matter is the fact that Senator Olympia J. Snowe (R-ME), a strong proponent of the Medicare drug benefit, has declared her intention to offer an amendment to S. 3018 in order to fund such a benefit, thus driving up the cost exponentially.

Despite these problems it is clear that most members of Congress and the White House regard the physician “fix” as the most pressing issue in the whole provider complex. In an interview on October 3, Centers for Medicare & Medicaid Services Administrator Thomas Scully said: “Our [the Administration’s] general strategy is physician payment has to be fixed…. The SCHIP [State Children’s Health Insurance Program] …we certainly have to fix that. We don’t see a driving need for other things.” By the same token, however, the official White House position is that any provider “fixes” must be budget-neutral, that is, gains by one provider group must be offset by cuts to another.

No one knows at this writing the shape of the legislative “end game” to deal with at least these issues. Given the fact that Congress has not sent even one of the 13 appropriations bills to the President, it is clear that Congress will need to pass a series of continuing resolutions to permit operation of the federal government in the weeks ahead. The physician and SCHIP “fixes” and even others could be attached to a continuing resolution. We do not know, but what we do know is that it is important to maximize the pressure on Congress, and ASA — along with the other specialties — is doing that in every way that we know how.

One final point: By the time the next issue of the NEWSLETTER is published, we should know CMS’ decision on whether anesthesia work values should be increased. Both ASA and the American Association of Nurse Anesthetists (AANA), working together, have generated significant congressional interest in this issue, and we remain hopeful that CMS will increase values. At the same time, if Congress does not act on the physician update issue, it is reasonable to expect that CMS is going to be reluctant further to cut other physicians’ reimbursement in order to pay for increased anesthesia values.


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