Reform Update: Immigration bill draws quick response from providers

The nation's healthcare providers quickly weighed in on the sweeping immigration bill that the Senate passed on Thursday, with some applauding the measure's healthcare workforce provisions and others criticizing the bill for not addressing healthcare coverage for undocumented immigrants and their children.

“The bill has really positive provisions that we think are going to help the healthcare workforce shortage issues for physicians but also for nurses and other allied health,” such as physical therapists and occupational therapists, said Samantha Burch, vice president of legislation and health information technology at the Federation of American Hospitals, in an interview. The federation posted a blog about a couple of the bill's key provisions, such as permanently authorizing the Conrad state 30 J-1 Visa waiver program, which allows state health departments to sponsor up to 30 international medical graduates each year.

According to an e-mail from Burch, the Senate bill increases the number of J-1 Visa waivers to 35 from 30 if at least 90% of the waivers were used nationwide the previous year. If that 90% threshold is met every fiscal year, then the number of waivers will increase by five up to a maximum of 45 waivers—and then a 95% threshold is required. The legislation also provides each state with three additional waivers for positions within academic medical centers.

Other groups focused on what the Border Security, Economic Opportunity and Immigration Modernization Act—which the upper chamber passed in a 68-32 vote with Vice President Joe Biden present—did not include.

“As children's health experts and advocates, we remain concerned that the legislation does little to address the multiple barriers to accessing comprehensive, affordable, and culturally and linguistically effective healthcare services faced by many children in immigrant communities,” Dr. Thomas McInerny, president of the American Academy of Pediatrics, wrote in a letter to lawmakers. The correspondence also noted that immigrant children represent the fastest growing segment of the population, with one in every four children living in an immigrant family.

And America's Essential Hospitals (formerly the National Association of Public Hospitals and Health Systems) expressed concern that the Patient Protection and Affordable Care Act won't reach the country's 11 million undocumented immigrants and that this patient population must currently rely on a hodgepodge of funding sources that in most cases pays for only limited services.

“This inadequate framework also leaves essential hospitals unreimbursed for costly related services, such as transportation and follow-up care,” Dr. Bruce Siegel, the group's president and CEO, said in a statement.

All eyes now shift to the lower chamber for its action on immigration reform. This week the House Judiciary Committee passed a few immigration bills, including one that Burch said includes all of the Senate bill's physician provisions. Rep. Luis Gutierrez (D-Ill.), a member of the Judiciary Committee and also a member of a bipartisan group of seven House members working on a comprehensive immigration bill, had choice words for House Speaker John Boehner (R-Ohio) after the bill passed.

“As they say in the NFL draft, 'Mr. Boehner, you are on the clock,'” Gutierrez said in a statement. “Every passing day will put more pressure on Speaker Boehner to act or else have the House Republicans once again be seen as an obstacle to enacting popular, sensible legislation for the American people.”

HHS on Friday released a final rule on contraception coverage and religious organizations (PDF) that the administration noted closely follows its February proposed rule. After reviewing some 400,000 public comments, HHS determined that not-for-profit religious organizations—such as hospitals and universities—that object to the contraception coverage requirement will not have to contract, arrange, pay for or refer contraceptive coverage, but that coverage would still be provided to women in their health plans at no cost to them. Regarding self-insured plans, any religious organization that objects to the requirement must notify its third-party administrator, which in turn would inform health plan enrollees that the administrator is providing or arranging separate no-cost payments for contraceptive services as long as the enrollee stays in the health plan. The Catholic Health Association is “reviewing the final rules and will have no comment until we have had time to do that,” spokesman Fred Caesar said in an e-mail. “That will be Monday at the earliest.”

Members of the federal Commission on Long-Term Care met for the first time this week, said David Lipschutz, a policy attorney at Center for Medicare Advocacy. Lipschutz attended the Thursday meeting in Washington in place of panel member Judith Stein—the center's executive director—who could not make it.

Commission members heard testimony from four expert witnesses, including Kirsten Colello, a specialist in health and aging policy at the Congressional Research Service, and Marc Cohen, chief research and development officer at LifePlans, a company that works with long-term care insurers and providers and manages a national network of more than 4,000 nurses for clinical interventions, such as care coordination and fall prevention. The commission is in the process of deciding on the date for the next meeting this summer, according to a spokeswoman.

Ahead of the one-year anniversary of the U.S. Supreme Court's decision to uphold the Patient Protection and Affordable Care Act, the U.S. Chamber of Commerce—which represents more than 3 million U.S. businesses of all sizes—released a report that includes the group's recommendations to address healthcare access, cost and quality by building on private-sector efforts to improve value. “While the Chamber opposed the health reform law during the legislative debate, these recommendations provide thoughtful and carefully constructed changes that can be used to ease the impact of implementation, especially on small businesses; mitigate and control the growth of unnecessary costs; and protect and improve the private sector coverage that millions of American have long valued,” Bruce Josten, the Chamber's executive vice president of government affairs, said in a news release. A year ago, the Chamber established a council of member companies—including hospitals, insurers and drug companies—to work on the report. Former CMS Administrator Mark McClellan led the group's efforts.

Follow Jessica Zigmond on Twitter: @MHjzigmond