All anesthesiologists are called to arms!! The August Congressional Recess is upon us. Members of the U.S. House and Senate have left Washington for various destinations, including lengthy stays in their District and State offices. As they spend time with their constituents at town hall events and local meetings, one topic will undoubtedly dominate the agenda: health care reform.
Though the House and Senate will not convene again until September 8, this "recess" is hardly a typical break. Stakes are high for completing health care reform according to President Obama's aggressive timeline. Many groups -- lawmakers, lobbyists, physicians, patients and more -- will use this time to advance their agendas and push their priorities, getting ready for the health care debate to resume in full-force after recess.
ASA members must be actively involved in this debate. Your voices need to be heard clearly. The Congressional Recess is NOT THE TIME FOR REST, BUT FOR ACTION.
This message is intended to provide you with an update on the latest in the rapidly changing arena of health care reform, and to equip you to take a number of important actions over the August Congressional Recess.
Partial victory: House committee votes to de-link public plan from Medicare rates
Throughout the health reform debate, ASA has consistently lobbied against any plan based upon Medicare's unacceptably low payment rates. On a positive note, the House Energy and Commerce Committee adopted an amended version of H.R. 3200 that, while not perfect, generally allows physicians and hospitals to negotiate payments under the proposed public plan option. This has been one of key provisions demanded by ASA. Late Friday night just as the entire House was adjourning for the August recess, the bill passed the Committee by a vote of 31-28. Passage of the bill out of committee was supported by 31 Democrats and opposed by all 23 Republican members who were joined by five Democrats.
The provisions allowing providers to negotiate for payments under the public plan were part of an agreement between the Committee leadership and fiscally conservative "Blue Dog" Democrats. The actual amendment, authored by Blue Dog Coalition Health Care Task Force Chairman Rep. Mike Ross (D-AR), and supported by ASA, de-links the public plan from Medicare rates and "[P]rovides additional level playing field requirements for the public plan," among other provisions. The amendment passed the Committee 33-26. Thanks to many of you who weighed in with your Members of Congress to get this amendment passed! However, there is much more yet to be done.
Reality check: it's not over 'til it's over
While de-linking anesthesiologists' payment in any new plan to Medicare rates is an important step in the right direction, it is not certain that the House will ultimately vote on a version of H.R. 3200 that includes the desired negotiated payment rates. The Energy and Commerce Committee language must be merged with alternative versions of H.R. 3200 previously passed by the House Ways and Means and Education and Labor Committees -- the two other House committees with jurisdiction over health care reform. Both the Ways and Means and Education and Labor versions of the legislation include a public plan with Medicare payment rates. Members of these committees may oppose the Energy and Commerce/Blue Dog provisions on the public plan. We need to let our voices be heard that this would be unacceptable!!!
Moreover, in response to the Ross Amendment, a group of liberal House Democrats is fighting hard to re-link the public plan option to Medicare payment rates. Last week the Congressional Progressive Caucus (CPC) sent a letter to House Speaker Nancy Pelosi and the chairmen of the key health care committees demanding that health reform legislation include a Medicare rate-based public plan. As most of you are aware, such an action would be devastating for anesthesiology payment.
From the letter:
"Any bill that does not provide, at minimum, for a public plan option with reimbursement rates based on Medicare rates-not negotiated rates-is unacceptable."
Nearly a month ago, the Senate Health, Education, Labor and Pensions (HELP) Committee adopted the "Affordable Health Choices Act", its version of health reform legislation. Like the House Energy and Commerce Committee legislation, the HELP bill includes a public plan option with negotiated rates, rather than a public plan based on Medicare payment rates. However, the final outcome remains uncertain because the HELP committee has narrow jurisdiction over health care issues and must wait for the Senate Finance Committee (the Senate's other health care committee) to act.
The Senate Finance Committee has been unable to reach an agreement on a number of issues and therefore did not release a bill before recess. A proposal is expected by mid-September. ASA is working hard with Senate Finance Committee members to ensure that their version of health reform does not include a Medicare rate-based public plan option. We need your help on this also.
How will these bills become a health care reform law?
Once the House and Senate reconvene, each chamber still has a considerable amount of work left before passing health care reform legislation.
In the House, the three health care committees -- Energy and Commerce, Ways and Means, and Education and Labor, or "Tri-committee" -- must merge their health reform bills. This merged package can then be sent to the full House for consideration.
On the other side of the Capitol, the Senate Finance Committee must adopt legislation, which should subsequently be merged with the bill adopted by the HELP Committee. Then the full Senate can consider the bill.
After each chamber has passed its version of the health reform legislation, any differences between the House and Senate versions must be reconciled in a Conference Committee. Once the Conference Committee settles on a final version, both the House and Senate must vote again on the finalized bill. The version passed by both chambers would be signed into law by the President.
Other voices in the debate
Many other groups have been vocal in their support of H.R. 3200.
As you know from my previous message, AMA offered early unconditional support of H.R. 3200. In response, I sent a letter to the AMA expressing my concerns about their actions. I am pleased that in a response to my letter, AMA leadership has indicated an awareness of our concerns and a renewed commitment to support de-linking a public plan option from Medicare payment rates. AMA president J. James Rohack, M.D., wrote that, "We intend to be fully engaged and consulted when the details of a final bill are negotiated, so that we are in a strong position to advocate strongly against the inclusion of objectionable provisions like a Medicare-based public plan." We will be watching for AMA's renewed support of this important issue.
A number of other organizations, including the American College of Surgeons and the American College of Physicians, have also announced support for H.R. 3200.
Among allied providers, the American Association of Nurse Anesthetists (AANA) announced its support for H.R. 3200 -- including a public plan option based upon Medicare payment rates. Indeed, the AANA letter of endorsement criticizes ASA's strong leadership in opposition to the use of unreasonably low Medicare payment rates in a public plan, despite the negative payment implications of such a plan for their own members. For the reform debate, AANA has prioritized efforts to expand already burgeoning nurse anesthetists training programs, and the results of an excess of CRNAs in the future have not been completely analyzed.
YOUR voice in the debate: Get involved
These next few weeks will be critical in the development of health reform legislation. As I previously noted, many groups -- including the Congressional Progressive Caucus, AANA, and even President Obama's administration -- are strongly supporting a public plan option based upon Medicare payment rates. We must be even stronger in our opposition of such efforts.
All ASA members are encouraged to take the following actions over the Congressional Recess:
Aug. 10-14: Let's inundate our Members of Congress with emails reminding them to de-link any public plan option from Medicare payment rates. Use CapWiz to write your Representative and Senators.
Aug. 17-24: Schedule a visit with your Representative or Senators in their local office. This provides a perfect opportunity to share ASA's messages in person, and to begin to establish yourself as a "key contact" if you haven't already. CapWiz provides contact information for legislators' District and State offices.
Sept. 3: Mark your calendar for the first ASA Tele-townhall, a conference call designed to provide a last-minute update before the House and Senate reconvene. You can call in and listen as I give a status report of current efforts, and you can also ask questions about the process and your involvement. ASA Washington office staff will provide call-in information and additional instructions in advance of the event.
Throughout August: Attend "Town Hall" meetings that your Representative or Senators may hold. You'll get a chance to hear his or her stance on health care reform, and can provide feedback when possible. President Obama has called for his supporters to attend these sessions in large numbers. Make sure your voice is heard by those who would prefer we be absent or silent. Click here to search for Town Hall events in your area.
I sincerely appreciate your involvement in our grassroots advocacy efforts. Please stay the course, stay on message, and stay in touch.
If you have questions or need additional information, please contact your ASA Washington office staff at (202) 289-2222.
Roger A. Moore, M.D.