The nation’s largest hospital lobby has braced itself for a fight against three main components of a massive Senate bill that aims to reshape the $2.5 trillion healthcare industry.
AHA presses for trio of fixes to merged Senate bill
The bill, a merger of two previously approved Senate packages that’s estimated to cost $848 billion over 10 years, was released last week and, at deadline, was headed for a key procedural vote over the weekend.
Ahead of that vote, Tom Nickels, senior vice president of federal relations for the American Hospital Association, said measures in the bill to create a national public health plan, expand coverage and withhold payment for certain types of hospital readmission need to be reworked in order to garner the group’s backing.
The association’s efforts will center on changes made in a bill by Senate Majority Leader Harry Reid (D-Nev.) that bridge legislative packages written separately by the Senate Finance Committee and the Senate’s health panel.
The AHA has opposed the creation of a national public insurance option but is not opposed to an approach that uses a health insurance cooperative.
Frank McDougall Jr., vice president for government relations at 369-bed Dartmouth-Hitchcock Medical Center in Lebanon, N.H., added that parts of the bill still need some massaging. McDougall said that concerns remain over how the public insurance option would ultimately pay providers and also on how payment cuts will play out even as more and more Americans gain coverage.
“We’re still looking with our eyes wide open,” he said.
Part of the AHA’s concern also is focused on federal estimates of how many individuals will be covered under the expanded health insurance provisions. The number is key to a deal struck between the AHA and power players in the White House and on Capitol Hill. The Congressional Budget Office figures that Reid’s plan would cover 92% of everyone residing in the U.S. despite their citizenship status. Ninety-four percent of legal U.S. residents would be covered. Under that tally, about 24 million residents would remain uninsured—about one-third of those would be unauthorized immigrants.
But the deal shaped by the AHA and other hospital associations is based on having 94% of all residents and 97% of legal citizens covered. “We need to work to beef up the coverage numbers,” Nickels said, adding that the legislative process and its often-confusing ways will allow for more changes in the coming weeks. “We’ll have that opportunity.”
One way to bolster coverage is to strengthen the penalties that would be levied against individuals and businesses that don’t purchase insurance, Nickels said.
“I think for us, and certainly for others in healthcare, the weakness of the individual mandate is a serious problem,” Nickels said.
The AHA is also eyeing a provision that expands a financial penalty against hospitals when patients are readmitted when they otherwise medically should not have been. The Senate’s merged bill is much broader in its scope than previous versions, Nickels said, and mirrors one found in the House bill that the AHA also opposed. As written, “it will capture a larger number of readmissions,” he said.
It would also call for a harder financial hit. Previous legislative versions would effectively make the pay cut based on the condition’s billable DRG. The new provision now extends to a hospital’s entire payment, “all of it, across the board,” Nickels added.
To be certain, nothing is etched in stone. The Senate’s arcane rules ensure that the bill that was introduced last week will almost certainly be reshaped before lawmakers are asked to vote it into law.
Starting in 2014, the bill creates a public health insurance option that requires states to participate unless they pass a law to opt out of it. The public option would work side-by-side with private plans in an open marketplace called an exchange. Co-ops would also be created, allowing groups to band together in order to negotiate lower coverage costs.
Additionally, starting next year the bill would prevent private insurers from denying coverage to individuals with pre-existing conditions. It would also prevent insurance companies from dropping individuals once they become ill.
The bill also begins to change how providers are reimbursed (See story, p. 10). And, it would erase an expected 21.2% physician Medicare payment cut slated for 2010 and replace it instead with a 0.5%, one-year only update. The House chose to tackle that issue in a stand-alone bill (See story below).
Device manufacturers earned something of a reprieve in the Reid legislation. Originally slated for about $38 billion over 10 years in a new tax, the merged bill cuts it back to $19.3 billion.
Herbert Pardes, president and CEO of 2,192-bed New York-Presbyterian Hospital, called the bill’s debut this week “a tremendously important step.”
“My hope is that we’ll achieve reform,” Pardes said. “I think it’s very important for the country, for the economy and for the hospitals.”
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.