Government
Reform bills give some lawmakers sticker shock
■ The Finance Committee delays hearings on national health system reform legislation, while House leaders unveil a Medicare pay formula replacement.
By Doug Trapp — Posted June 29, 2009
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Washington -- Months of rhetoric about adopting bipartisan health reform legislation ran into harsh reality as lawmakers received higher-than-expected cost estimates and began hearings to amend legislation in both the House and Senate.
House Democrats unveiled their national health reform measure on June 19, including a proposed fix for Medicare's sustainable growth rate formula for physician pay. Also, the Senate Health, Education, Labor and Pensions Committee began amending an incomplete health reform bill on June 17. The Senate Finance Committee delayed its markup until July to trim the cost of its measure and to continue negotiating its contents.
The Democrats' bills have their roots in comprehensive health system reforms Massachusetts adopted in 2006. The legislation unveiled so far would launch health insurance exchanges to give consumers more health plan choices, expand Medicaid coverage, require individuals to have at least basic health coverage, offer subsidies to help low- and moderate-income people buy health insurance, and end exclusions based on health status.
Senate Finance Committee Chair Max Baucus (D, Mont.) had hoped to mark up his panel's reform bill by mid-June, but disagreements over a public plan option and a Congressional Budget Office cost estimate of $1.6 trillion over a decade led him to delay hearings. Baucus pledged to deliver a bipartisan bill costing no more than $1 trillion and that's offset with revenues. He's working with the panel's ranking Republican, Sen. Charles Grassley (Iowa) on these goals.
The House Energy and Commerce Committee, House Ways and Means Committee, and House Education and Labor Committee began markup hearings June 23 on their 852-page bill, the Affordable Health Choices Act. The measure -- the only one so far to address the sustainable growth rate issue -- would prevent the 21% Medicare physician pay cut in 2010 and future cuts. The new payment formula would begin fresh, with annual updates based on the gross domestic product plus 1% for most services and 2% for primary and preventive care. House Democrats estimated that the fix would cost less than $300 billion over a decade.
The House bill also would expand Medicaid to cover Americans earning up to 133% of the federal poverty level, offer sliding-scale subsidies to help people earning between 133% and 400% of poverty buy health insurance, require most employers to offer coverage or else contribute to a health care fund, and create a public health insurance plan with pay similar to Medicare fees but with voluntary physician participation.
"This draft sets out a very practical and uniquely American proposal. It fulfills President Obama's commitment to provide quality, affordable health care for all," said House Energy and Commerce Committee Chair Henry Waxman (D, Calif.). The bill did not have a cost estimate at this article's deadline.
House Minority Leader John Boehner (R, Ohio) began hammering at the Democrats' legislation as soon as it was released. Republicans had no input in the draft and do not want significant new government spending on health care, he noted. "At a time when we have seen spending out of control here in Washington, I think it is better to take the current system, to make the current system work better for those who cannot get insurance," Boehner said June 20.
House Republicans, for example, would prefer to offer a tax deduction to help people without employer-sponsored health insurance buy coverage, to allow Medicaid and Children's Health Insurance Plan enrollees to buy private coverage and to give employers more options to reward employees' healthy behaviors. Those health reform principles were outlined June 17 by the House Republican Health Care Solutions Group, led by Rep. Roy Blunt (Mo.).
Pinch-hitting for Kennedy
The Senate Health, Education, Labor and Pensions Committee on June 17 became the first panel to start marking up a health system reform bill, albeit an incomplete one. Sen. Chris Dodd (D, Conn.) -- chairing the committee in place of the ailing Sen. Edward Kennedy (D, Mass.) -- left out controversial sections dealing with a public health plan option and an employer health insurance mandate to entertain GOP alternatives.
The gesture didn't go far. The hearings on the Senate HELP bill, the Affordable Choices Act, began with Republicans complaining loudly that they were not asked to help write the legislation and that they were amending a bill without a complete cost estimate. The CBO estimated on June 15 that the unfinished measure would cost about $1 trillion over 10 years but would cover only 16 million of the nation's 46 million uninsured. That estimate did not take into account an anticipated Medicaid expansion, among other provisions.
"I chaired this committee for a few years, and I don't remember marking up a bill that we didn't have a score on," said Sen. Judd Gregg (R, N.H.).
But the Senate HELP Committee's top Republican, Mike Enzi (Wyo.), struck a more conciliatory tone after GOP members had the chance to offer amendments and voice some concerns. "We're listening to each other and we're making changes, and that helps," Enzi said.
So far, those changes have not included medical liability reforms, though Obama told the American Medical Association House of Delegates during its Annual Meeting in Chicago on June 15 that he would consider supporting some reforms, such as helping physicians reduce defensive medicine by improving evidence-based guidelines.
The initial Senate HELP bill had no medical liability provision, so Enzi offered as an amendment a bill he wrote with Baucus in 2007 that would provide grants to states to develop alternative methods of settling disputes over health care errors. But Dodd said he is not inclined to support including medical liability reform in the HELP legislation. "I'm not convinced that this is a legitimate issue and it will have that much impact," he said.