The House healthcare reform bill attracted lukewarm support from major healthcare provider lobby groups, including strong opposition among several member groups of the American Medical Association.
House action galvanizes both sides of the aisle
As lawmakers hunkered down to resolve outstanding issues on coverage of abortions and illegal immigrants, aiming for a vote as early as Nov. 7, the healthcare industry offered their opinions on the bill and, in some cases, their pet concerns. The sweeping healthcare package, expected to cost more than $1 trillion over 10 years, according to some projections, aims to cover 96% of Americans through various coverage and insurance market reforms, expanding Medicaid to 150% of the federal poverty level and creating a health insurance exchange that would include a public insurance option. Once the House finishes its work on comprehensive health reform, its next task would be to consider a stand-alone bill to revise Medicare’s physician-fee schedule, an issue of great importance to the physician lobby. In a teleconference, House Majority Leader Steny Hoyer (D-Md.) said the House could vote on this bill as early as Nov. 16. The American Hospital Association declined to take a stand either way on the broader health reform bill—and is worried about some last-minute changes to it—while the AMA offered its support, falling short of full endorsement. Other supporters include the American College of Physicians, American Academy of Family Physicians, American Osteopathic Association and Medical Group Management Association. But a slew of AMA member groups actively opposed it, including the American Association of Neurological Surgeons, American Society of General Surgeons, Medical Association of Georgia, Florida Medical Association and the South Carolina Medical Association. The bill would create “a staggering volume of new federal regulatory requirements for medicine, isn’t sustainable from a budget standpoint, includes a ‘public’ heath insurance option that may lead to a single-payer system,” and would discourage proven medical liability reforms such as limiting lawyer fees and enacting malpractice caps, said Tom Kornegay, a spokesman for the Medical Association of Georgia, in an e-mail. Nevertheless, the support of the AMA and other physicians groups, along with the AARP, was viewed as a coup for the effort ahead of a possible vote over the weekend. The Affordable Health Care for America Act “is not the perfect bill, and we will continue to advocate for changes, but it goes a long way toward expanding access to high-quality, affordable health coverage for all Americans, and it would make the system better for patients and physicians,” AMA President J. James Rohack said. Ideally, Medicaid should not be the only choice of coverage for low-income Americans, said Rohack, adding he would like to see a greater focus on physician workforce issues in the legislation. Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Health Subcommittee, hailed AARP CEO Barry Rand’s proclamation that the bill would improve benefits for Medicare and create needed health insurance market reforms. “Our bill closes the Part D ‘doughnut hole,’ eliminates cost sharing for preventive coverage and improves access for low-income seniors and people with disabilities,” Stark said in a written statement of the bill’s benefits to AARP members. Stark was also fueled by a letter he received from the CMS, confirming the House health reform bill would extend the Medicare Trust Fund by five years. President Barack Obama also welcomed the support from the AARP and other lobbying groups. “Now that the doctors and medical professionals of America are standing with us, now that the organizations charged with looking out for the interests of seniors are standing with us, we are even closer,” he said at the White House last week. The AHA didn’t take a strong public stand. Initially encouraged that the bill would place restrictions on the development of physician-owned hospitals, the AHA remains concerned “about carve-outs that begin to undermine” this language, AHA spokeswoman Alicia Mitchell said. A supplementary document or “manager’s amendment” to the bill included a provision that would exempt certain physician-owned hospitals—those that care for a higher share of Medicaid patients than their local competitors—from the bill’s proposed restrictions on these hospitals. The feud over physician hospitals flared up last week in McAllen, Texas (See story, p. 12). Language in the bill to phase out the State Children’s Health Insurance Program has also ruffled some feathers. Under this measure, populations that would otherwise be enrolled in SCHIP would instead get coverage either through Medicaid or the health insurance exchange, thus rendering SCHIP obsolete. Phasing out the program also eliminates the problem of reauthorizing the SCHIP statute, Rep. Lois Capps (D-Calif.), said in an interview. Some SCHIP advocates, however, don’t believe these coverage alternatives are adequate enough to cover children. And the Senate reform bill does preserve SCHIP as a stand-alone program. Also, some providers were unhappy with a change to a Medicaid drug reimbursement provision (See story left). Meanwhile, with the Senate’s top Democrat publicly waiving any kind of deadline for passing a bill, the members of the upper chamber continued to meet behind closed doors, though in a less-frenzied manner from previous weeks. So far, Senate Majority Leader Harry Reid (D-Nev.) has played his hand close to the vest. A bill he helped craft currently awaits a full assessment from the Congressional Budget Office, which continued to work and rework legislative scenarios in private. It’s expected to deliver a final price tag as soon as this week. Last week, House Republicans issued their own reform legislation whose main provisions included medical liability reforms and giving states the tools to create innovative healthcare reform programs. It’s unlikely the GOP legislation will be adopted.
—with Matthew DoBias and Andis Robeznieks
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