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Washington Update: ACS, physician community support some health care reforms, oppose others
The Advocacy and Health Policy Division of the American College of Surgeons compiled the information in this report for ASCRS News.
United States Capitol

In November, the House of Representatives, in a 220 to 215 vote, passed its version of health reform legislation, the America's Affordable Health Choices Act (H.R. 3962). The American College of Surgeons offered its support for the health care reforms included in the Medicare Physician Payment Reform Act (H.R. 3961) and America's Affordable Health Choices Act (H.R. 3962) because H.R. 3961 would permanently fix Medicare's broken physician payment system, and because H.R. 3962 would implement health system reforms that would expand coverage and help ensure patient access to surgical care, including measures that would improve trauma systems.

In December, the Senate, in a 60 to 40 vote, passed its version of health reform legislation, the “Patient Protection and Affordable Care Act.” In a December 1 letter to Senate Majority Leader Harry Reid (D-NV), 19 surgical organizations expressed opposition to the initial version the "Patient Protection and Affordable Care Act of 2009" for several reasons.

These reasons for opposing H.R. 3590 included the creation of an unaccountable Medicare board whose recommendations could become law without congressional action, budget neutral payment increases for primary care and general surgery, an application fee for physicians to participate in Medicare, the absence of Medicare payment reform, and a tax on cosmetic surgical procedures.

The legislation passed by the Senate in December did include several improvements—namely removal of budget-neutrality, the application fee, and the cosmetic surgery tax. However, a number of problematic provisions, including the Medicare board, now named the Independent Payment Advisory Board (IPAB) remained.

100 Representatives express opposition to Medicare Board
In a December 17 letter to Speaker Pelosi, 69 representatives, led by Rep. Richard Neal (D-CA), wrote to express their strong opposition to the creation of a Medicare board such as IPAB or IMAB in health reform legislation. Rep. Neal’s office re-opened the letter in January, and an additional 31 members added their name to the letter, stating their strong opposition to including IPAB/IMAB in health reform legislation. In total 100 members (67 Democrats, 33 Republicans) stated their opposition to the creation of a Medicare board in health reform legislation.

Medicare Physician Payment
In November, the House passed the Medicare Physician Payment Reform Act (H.R. 3961) in a 243 to 183 vote. H.R. 3961 would reset the budget baseline of the sustainable growth rate (SGR), and it would replace the single spending target of the SGR with two spending targets, based on type-of-service, that would be used to determine Medicare reimbursement for physician services.

The first category of services would include all evaluation and management (E&M) and office visits, and the second category would include all other services, including major surgical procedures. The bill would increase this annual target for growth to GDP+2 percent for the E&M category and to GDP+1 for the category for all other services.

Back in October, in a 47 to 53 vote, the Senate had failed to gain the requisite 60 votes to invoke cloture and allow consideration of the Medicare Physician Fairness Act of 2009 (S. 1776). While S. 1776 did not include the reforms included in H.R. 3961, it would have reset the baseline and prevented Medicare payment levels from falling below 2009 levels.

Congress passes temporary measure to avert Medicare payment cut
On December 19, President Obama signed the Department of Defense appropriations bill (H.R. 3326).into law. Included in the bill were measures to temporarily halt the 21 percent cut in the Medicare conversion factor that was scheduled to take effect on January 1, 2010. The legislation included a provision that prevents the cut from taking effect and will maintain the current conversion factor of $36.0666 for sixty days (through the end of February 2010). If Congress does not act prior to March 1, a 21 percent cut in the Medicare conversion factor will take effect.

With Washington, DC digging out of a historical snowstorm, it appears the Senate will need a two-step process to address the looming 21 percent cut before the end of the month. Senate Majority Leader Reid’s initial plan was to include another short-term extension in a larger jobs-related bill.

Because of the inclement weather and the weeklong President’s Day recess, it is unlikely that the Senate will be able to vote on the jobs bill before March 1st. Therefore, Leader Reid will expedite a piece of legislation that prevents the Medicare cuts for 7 days – through March 7th – until the Senate can take up the jobs bill.

As currently drafted, the jobs bill contains a 7-month extension, which would maintain Medicare physician payments at 2009 rates through the end of September. Should Congress fail to act intervene by September 31st, the 21 percent cut would go into effect. The entire physician community continues to stress the need for a full and permanent Medicare payment reform.