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November 2002
Volume 66 |
Number 11 |
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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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