GOP leaders in House plan to tighten reins on Obama's agenda

They have indicated that they will push for such Republican health policy priorities as medical liability reform.

By Doug Trapp — Posted Jan. 3, 2011

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Leaders of the incoming Republican-controlled House have indicated they will spend much of the next two years holding oversight hearings to question the Obama administration, trying to weaken the national health reform law by reducing funding for it, and reintroducing such health policy ideas as medical liability reform.

Less clear is how the new House committee leaders with jurisdiction over health care plan to address Medicare physician payment, which is scheduled to receive an across-the-board cut of more than 25% on Jan. 1, 2012.

A few of the new committee leaders have proposed Medicare pay reforms in past sessions of Congress. Rep. Michael Burgess, MD (R, Texas), the incoming House Energy and Commerce health subcommittee vice chair, has written several bills to repeal the sustainable growth rate formula that helps determine physician rates. He also was the only GOP House member in November 2009 to vote for a Democratic bill that would have replaced the SGR with a formula based more closely on the costs to physicians of providing care.

Incoming House Speaker John Boehner (R, Ohio) and incoming House Energy and Commerce Committee Chair Fred Upton (R, Mich.) said Dr. Burgess will have a leading role on health care issues in the Republican caucus. Said Boehner: "He's been here every step of the way in leading legislation that will bring real reform to our health care system."

Incoming House Budget Committee Chair Paul Ryan (R, Wis.) proposed a deficit reduction plan -- "A Roadmap for America's Future" -- in early 2010 that would change Medicare from a program of defined benefits for seniors to one that provides set subsidies to buy qualified private health plans. People 55 and older at the time of the plan's adoption would retain their traditional benefits. However, few fellow Republicans embraced Ryan's proposal.

Quest for SGR reform

Physician organizations, including the American Medical Association, once again will be pushing for a permanent solution to the Medicare doctor pay problem in 2011, this time with a legislative branch whose control is split between the two major parties.

But Congress has a habit of enacting even temporary SGR pay patches at the last minute, said Michael Franc, vice president of government relations for the Heritage Foundation, a conservative think tank based in Washington, D.C.

In an interview with American Medical News, Dr. Burgess said physicians in 2010 endured the least stable year on record when it came to Medicare physician payment. Congress temporarily delayed Medicare pay cuts five times between Dec. 19, 2009, and Nov. 30, 2010.

"I'm going to use every bit of equity I have now, in the committee and on the conference, to push a resolution" on the SGR issue, Dr. Burgess said.

Incoming House Energy and Commerce health subcommittee Chair Joe Pitts (R, Pa.) said by e-mail that physicians deserve to know for certain they will be paid fairly for the Medicare services they provide. "I plan to hold meetings and hearings next year to gather input from all stakeholders and then formulate a solution."

The Heritage Foundation's Franc said Medicare pay reform could be wrapped into a federal deficit reduction effort, should Congress decide to make such legislation a priority. Deficit reduction efforts could become more urgent during the year if large states such as California or New York start defaulting on their debts.

Health reform changes

Still, many of the incoming House committee chairs, including Pitts, said they first will focus on rolling back elements of the national health reform law they consider bad policy. Pitts said he would like to retain health reform law provisions ending coverage denials for preexisting conditions and allowing dependents to remain on their parents' coverage until age 26. However, he supports repealing many of the central elements of the statute.

But the Democratic-controlled Senate will stand in the way of any effort to repeal the entire health reform law, said Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy for the American Enterprise Institute, a conservative think tank in Washington, D.C. The Senate also probably will block House efforts to redirect funding in the health reform law to pay for other priorities, such as an SGR repeal.

"Just because the Republicans control the House doesn't mean they will be able to push forth a positive agenda on health," he said.

However, Antos said bipartisan support could emerge for some type of medical liability reform legislation. "This is not an area where there's such a huge political divide that you couldn't do anything."

House GOP leaders also want to increase oversight of the Obama administration. Dr. Burgess said a number of panels have been created since adoption of the health reform law that should be examined, such as the Office of Consumer Information and Insurance Oversight. The Dept. of Health and Human Services formed the office to help implement the new insurance market rules in the health reform law, but most members of Congress don't realize it exists, Dr. Burgess said.

He also is interested in hearing more about the Medicare Independent Payment Advisory Board, which was created by the health reform law to propose methods to extend Medicare's solvency, possibly in part by cutting pay to health professionals.

Upton is considered by observers to be a moderate Republican, but he pledged to increase oversight over the executive branch.

"The Obama administration is on notice -- they will not be allowed to regulate what they have been unable to legislate," Upton said in a statement.

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New committee bosses

Republicans won a majority of House seats in the November 2010 elections and are therefore taking control of the chamber's committees for the 112th Congress, which begins in January. Lawmakers chose committee leaders for their respective parties in November and December, including leaders of panels with jurisdiction over health care or health care spending.

House Committee Chair Ranking Democrat
Appropriations Hal Rogers
(R, Ky.)
Norm Dicks
(D, Wash.)
Budget Paul Ryan
(R, Wis.)
Chris Van Hollen
(D, Md.)
Energy and Commerce Fred Upton
(R, Mich.)
Henry Waxman
(D, Calif.)
Oversight and Government Reform Darrell Issa
(R, Calif.)
Elijah Cummings
(D, Md.)
Ways and Means Dave Camp
(R, Mich.)
Sander Levin
(D, Mich.)

Source: House Republican Conference, House Democratic Caucus, December 2010

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