As Congress marches forward with a number of varied proposals for health care reform, I wanted to take the opportunity to update you on key developments and ASA’s role in the ever-changing debate. Every day, Congressional committees, individual lawmakers, policy think-tanks, associations and other groups release their suggestions for reform. In the midst of this cacophony of ideas, ASA maintains its commitment to a bipartisan approach to sustainable, responsible reform that ensures access to health insurance for all Americans and that preserves the strength and vitality of our specialty.
Currently, the key health care-related committees in both the U.S. House and Senate are working to compile information that will be the basis of separate House and Senate reform bills. Looking forward, each body will likely compile its own reform initiative and attempt to pass it. If successful in gaining passage, representatives of each body will later meet in a conference committee to try to reconcile their different versions. If the differing versions can be reconciled, the House and Senate will again have to vote one final time on final package.
The President and the House and Senate Democratic leadership have set target date for House and Senate passage of respective initiatives by the start of the annual August Congressional recess – the first or second week in August. House and Senate negotiators could then meet during August and present a consensus package after Labor Day. This timeline is ambitious and subject to change due to the vagaries of the Congressional legislative work schedule and the ability of Congressional leaders to develop a consensus on key aspects of reform.
In the Senate
In recent weeks, the Senate Finance Committee has been at the forefront of health care reform discussions. The Committee, one of two Senate committees with jurisdiction over health care reform efforts, has held a series of three roundtables to discuss options for health system reform. Roundtable topics have included delivery system reform, health insurance coverage and health reform financing. It is likely that the Senate’s reform proposal will ultimately be derived from these roundtable sessions.
Following each roundtable, the Committee releases a “Description of Policy Options” offering potential policies for inclusion in a health system reform package. So far, the Committee has released two such options papers: “Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans,” and “Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs.”
Members of the Committee have affirmed that the proposals contained in the documents are simply options for discussion, and that no final decisions have been made regarding moving forward on any of the issues. However, these policy documents do provide a glimpse of the types of proposals we could expect to see in the coming weeks. We intend to provide comments on all the option papers as they are released.
Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, has reiterated that his committee plans to mark up health care reform legislation by the end of June to assure full Senate consideration by the August recess.
The Senate Health Education, Labor and Pensions Committee (HELP), the other major health care committee, has held hearings on reform issues but has yet to issue any policy documents.
In the House
In the House, both the House Ways and Means and Energy and Commerce Committees have held numerous hearings on different aspects of reform.
As health care reform discussions escalate in the House and Senate, please be assured that ASA continues its involvement in every step of the process. ASA’s Washington, DC lobbying staff have participated in dozens and dozens of meetings with lawmakers and Capitol Hill staff. Additionally, we just concluded our annual Legislative Conference during which nearly 500 of our State Component leaders went to Capitol Hill to meet with Members of Congress and their staff to educate them about anesthesiology and the implication of reform for our specialty and the patients we serve.
In my role as president of ASA, I have been honored to represent the society in several high-level meetings with Members of Congress including members of the Senate Finance Committee; key Congressional staff including the key health policy advisor from the House Democratic leadership; and the Administration, making sure that our positions are understood and acknowledged.
Most recently, in response to the Senate Finance Committees options paper regarding delivery system reform, I offered comments commending the Committee’s diligence, but also voicing ASA’s concerns about some facets of the proposal. For example, ASA opposes an across-the-board reduction in payments for all services to finance a bonus for certain providers, including primary care and general surgery. Additionally, ASA reiterated its belief that Congress must repeal Medicare’s unworkable Sustainable Growth Rate formula (SGR) and replace it with an updated system that more accurately reflects the cost of providing health care.
Also relevant to the current health care debate, I was recently asked to testify before the Republican Policy Committee on issues central to health care reform. During the discussion I conveyed ASA’s consistent concerns about the physician reimbursement elements of a “public plan option” – a potential new government plan to compete with commercial insurance, possibly built upon Medicare payment levels. The public plan is among a series of loosely defined reform options under consideration in the U.S. Senate and House of Representatives.
As you may know, a number of key members of the U.S. House and Senate strongly support a public plan option. This support is based upon these lawmakers concerns about the past and current practices of some commercial insurers and an increased willingness to make the insurers “honest.”
ASA remains open to a wide range of options for health reform, but emphasize that if Congress pursues any new public health insurance plan, it cannot be an expansion of Medicare or its unacceptably low payment rates. Medicare has long underfunded payments for anesthesia services and discounted payments for pain services. An expansion of such a flawed funding mechanism to a larger segment of the population would be unsustainable for the medical specialty of anesthesiology.
We continue educating Congress and the Administration that the current physician Medicare payment structure is a house of cards that is close to collapsing as the Medicare trustees have just warned us yet again. Right now, we are facing a 21% payment reduction scheduled for 2010 because of the SGR formula. Building upon that house of cards with a Medicare buy-in or public plan based upon Medicare is simply not sustainable and could ultimately harm patient access to medical care, as well as anesthesiologists and their ability to provide care to patients.
There are many potential threats to our specialty under discussion by lawmakers. However, I believe the Medicare public plan option remains the gravest for our specialty at this time. Accordingly, while we wait for additional details on health care reform proposals, this should remain our consistent message: should Congress decide to pursue a public plan option, it must not be built upon the unsound foundation of the Medicare program.
Undoubtedly, health care reform will encompass dozens of issues, and will likely grow more complicated with each passing day. ASA will continue its engagement with key lawmakers and members of the Administration to ensure the continued strength and vitality of our specialty.
Throughout these discussions, please stay informed and involved. This email is the latest update, and I expect to send you many more in the coming weeks and months. Also, our Washington Office staff will provide ASA members with additional information through the ASA website at www.asahq.org/Washington/healthcarereform.htm.
Roger A. Moore, M.D.