As Congress continues
moving full-speed ahead toward enactment of health care reform
legislation, it is absolutely essential that ASA members understand the
policies, procedures and politics involved. Because new information
and developments emerge from Capitol Hill on a minute-by-minute basis,
we want to provide you as many opportunities as possible to stay
informed and involved.
I would like to provide you with a brief update about the ever-changing debate.
U.S. House of Representatives
coming Saturday, the House is tentatively slated to vote on the new
H.R. 3962, the “Affordable Health Care for America Act.” The bill is a
significantly modified version of H.R. 3200 previously adopted by the
House Ways and Means, Energy and Commerce, and Education and Labor
Most notably for ASA,
H.R. 3962 includes a public plan that has moved away from payment rates
tied to Medicare rates for physician services, and instead provides
provisions toward freely negotiated rates. This significant change
has been ASA’s top priority, and ASA members are to be congratulated
for their tremendous grassroots efforts urging Congress to reject a
public plan tied to Medicare payment rates.
part of the debate on H.R. 3200, ASA strongly supported a proposed
amendment by Eddie Bernice Johnson (D-TX) that would have de-linked a
public plan option from Medicare payment rates for anesthesia
services. Now that H.R. 3962 includes negotiated payments allowing
anesthesiologists to be paid at commercial/private insurance levels,
Rep. Johnson’s amendment is essentially moot. ASA is extremely
grateful to Rep. Johnson for her leadership on this important issue,
and to ASA members for their hard work supporting the Johnson
amendment. The support it generated ultimately helped move House
leadership away from a public plan tied to Medicare rates.
universally, the new bill includes a number of important health
insurance reforms that would expand access to insurance coverage and
ensure broader fairness to patients by health plans. ASA is extremely
supportive of these provisions, which include guaranteed issuance,
guaranteed renewability, no lifetime or annual limits on care, the
elimination of pre-existing condition prohibitions, and other reforms.
H.R. 3962 would also create a health insurance “exchange” through which
certain individuals could purchase health plans.
told, these health insurance provisions would reduce the percentage of
uninsured patients to 4 percent of the population—a tremendous
improvement for patients and physicians.
is also pleased that H.R. 3962 would remove the anti-trust exemption
for health insurers and add enhanced requirements on insurers to direct
more premium resources directly toward patient care and away from
excessive executive compensation and investor profits. This beneficial
language would help level the playing field among providers and
While H.R. 3962 does not
include a fix to the Sustainable Growth Rate formula (SGR), House
leaders have reiterated their commitment to achieving needed reforms.
They plan to move forward with a new free-standing SGR bill, H.R. 3961,
based on the SGR reforms that ASA supported in H.R. 3200. ASA supports
H.R. 3961 to reform the SGR, avoid a 21 percent cut in January 2010,
and establish a pathway to future positive Medicare updates.
3962 includes thousands of health-related provisions. Legislation of
this magnitude and complexity is not without flaws. However, I believe
it represents a positive step forward in strengthening our health care
system without adversely impacting our specialty.
vote, while important, is by no means the end of this process. We
expect many more twists and turns before health care reform legislation
eventually becomes law.
the Senate, the Democratic leadership continues to work toward merging
proposals crafted by the Senate Finance and Health, Education, Labor
and Pensions (HELP) Committees.
ASA expressed strong support for provisions included in the Senate
Finance proposal that advanced the idea of health care “Consumer
Operated and Oriented Plan,” or CO-OPs. Specifically, ASA was
gratified that the proposal would allow for physician payments under
the CO-OPs program to be established through independent negotiations
between physicians and plans.
however, it has become apparent that the Senate may seek to target
Medicare payments for physician services to finance many of the bill’s
reforms. ASA is extremely concerned that legislation in the U.S.
Senate could involve multi-tiered payment cuts for anesthesia and other
proposals pending in the Senate include the potential for serious
physician payment cuts through four mechanisms: the establishment of
“Independent Medicare Advisory Commission” (IMAC), a new entity with
the power to implement across-the-board Medicare payment reductions;
so-called “resource utilization outlier” provisions that target
physicians who are perceived to be using excessive “resources” for
patient care without regard for patient acuity or complexity of care
required; a new punitive component of the Physician Quality Reporting
Initiative (PQRI) that exposes physicians to payment penalties; and
across-the-board payment reductions to support bonus payments to
primary care physicians and rural general surgeons.
ASA understands the enormous costs associated with health reform
legislation of this scale, we believe it is completely unacceptable to
finance the legislation with significant Medicare cuts to physicians.
Particularly for anesthesia services—which are paid for by Medicare at
a rate of 33 percent of what private insurers pay—it would be
outrageous to inflict further payment reductions.
expect an extremely complicated process moving forward with health
reform. After this weekend’s expected vote on H.R. 3962 in the House,
the Senate must still agree upon its final package, which could take
some time to accomplish. Once the Senate votes on health reform
legislation, it must be merged through a Conference Committee with the
bill that the House ultimately passes.
the health care debate began earlier this year, ASA has been on the
forefront of negotiations—as evidenced by our success in ensuring
negotiated rates in the House bill public plan option. Every day ASA
leaders, volunteers and staff are working tirelessly in Washington on
behalf of the medical specialty of anesthesiology. Please be assured
that we will continue our efforts in earnest as the legislative process
We welcome your
productive questions and feedback. ASA Washington staff is available
to provide additional information, and you are encouraged to call on
them for their expertise. They can be reached at (202) 289-2222.
Alexander A. Hannenberg, M.D.