SENATORS INTRODUCE BILL TO LIMIT AUTHORITY OF SECRETARY OF HHS: Last week, Senators Tom Coburn, MD (R-OK), John Barrasso, MD (R-WY), Rand Paul, MD (R-KY) and John Boozman, OD (R-AR), introduced, S. 2278, the Safeguarding Care of Patients Everywhere Act (SCOPE ACT). This legislation aims to protect the physician-patient relationship endangered by repealing section 1311(h) of the Affordable Care Act (ACA). According to the Senators, this provision grants the authority to the Health and Human Services Secretary to determine whether a doctor is providing “quality health care measures” and can prohibit health insurers from working with medical providers who don’t meet Secretary-established criteria for quality. This Senate bill is a companion to a House bill that was previously introduced by Rep. Phil Gingrey, MD (R-GA). At this time there is little legislative activity to report; however, NASS will continue to monitor this legislation and provide any updates as they become available.
SENATE SENDS SHORT-TERM SGR FIX TO PRESIDENT’S DESK:On Monday, the United States Senate voted 64-35 in favor of delaying cuts to Medicare physician reimbursements for one year as a result of the sustainable growth rate (SGR) formula. The bill, Protecting Access to Medicare Act of 2014, is identical to H.R. 4302 passed in the House of Representatives last week, was signed into law by the President. The bill received heavy criticism from physician groups as it allows the Centers for Medicare and Medicaid (CMS) to identify misvalued codes used under the Medicare Physician Fee Schedule. This provision is expected to cut $5 billion from the physician fee schedule over three years beginning in 2017 and will be used to partially offset the cost of the yearlong patch.
WHAT’S IN THE BILL: The short-term fix prevents the scheduled 24 percent cuts to physician’s Medicare reimbursements on April 1 and contains a positive 0.5 percent update for physicians through December 2014. Then, beginning in January 2015, physicians will receive a 0.0 percent update until the end of March 2015 when the patch will yet again expire. While the majority of medical groups had opposed this legislation, physicians earned a one-year delay of ICD-10 implementation, which was previously set to take effect this October. Other provisions in the bill include:
- establishing a program for appropriate use criteria on certain imaging services;
- delaying “two-midnight” rule for inpatient reimbursements through June 2015;
- delaying recovery audits (RAC) on unnecessary claims through March 2015.
OUTLOOK DOES NOT FAVOR REPEAL THIS YEAR: Despite the recent vote, leaders in the House and Senate said that passage of a short-term SGR fix doesn’t preclude Congress from passing full repeal and replacing legislation before the end of the year. However, considering the proximity to this November’s mid-term elections, and the traditionally inactive lame duck season that follows, the prospects of repealing the SGR this year are very slim. NASS will continue to urge members of Congress to work together to pass the previously agreed upon bi-partisan, bi-cameral SGR repeal legislation as the negotiations over offsets continue.
HOUSE PASSES SGR LEGISLATION WITH CONTROVERSIAL OFFSET: Last Friday, the House passed (238-81) legislation to replace the sustainable growth rate (SGR) that is paid for by delaying the implementation of the Affordable Care Act’s (ACA) individual mandate for 5 years. The vote was passed mostly on party lines, with 12 Democrats voting in favor of the bill. The House bill is not expected to be considered by the Senate, as Democratic leaders have indicated that the offsets were a non-starter for negotiations in that chamber.
SGR BALL IS NOW IN THE SENATE’S COURT: Senate Democrats are expected to bring an SGR bill (S. 2110) to the floor later next week that is compromised of the same SGR replacement policy as the House bill. However, unlike the House bill, the Senate’s bill contains zero offsets and incorporates additional Medicare riders, collectively known as “extenders.” Senate Finance Committee staff have indicated to NASS that their aim between now and next week’s Senate vote will be to convince as many Senate Republicans to support S. 2110. At this time it’s unclear whether Democrats can muster enough votes in the Senate to pass a stand-alone SGR bill without a payfor. When asked how Senate Democratic leaders were planning to persuade their colleagues on the other side of the aisle to pass their bill without offsets, Committee staff indicated that they were very confident in being able to reach an agreement on offsets once the Senate bill is passed. In other words, Democratic Senators are asking Republicans to take a leap of faith by voting to pass the SGR replacement bill without any offsets, and at the same time, giving Republicans assurances that a deal on payfors will be made once the bill goes to a conference between the House and Senate. This course may ultimately be the last path for the SGR to get across the finish line in time before another patch is set to expire by April 1, 2014.
NASS URGES CONGRESS TO ACT BEFORE APRIL FIRST DEADLINE: Last week, NASS sent a letter to House and Senate offices expressing support for the SGR replacement policy that was agreed upon by the three original authoring committees – House Ways & Means, Energy & Commerce and Senate Finance. In the letter, NASS also cautioned lawmakers over the use of partisan payfors that could be used to derail the bi-partisan spirit of the original legislation. NASS will continue to urge all Members of Congress to seek a bi-partisan solution to offset the cost of repealing the SGR. Additionally, NASS will once again gin up its grassroots efforts and urge NASS members to continue to send letters on the SGR to their federal legislators. NASS’ previous call to action generated nearly 500 messages to 104 House and 70 Senate offices.
On February 29th the House Energy and Commerce Health Subcommittee approved the Medicare Decisions Accountability Act of 2011 (H.R. 452) with no amendments and a bipartisan vote of 17-5. This legislation will repeal the 15 member Independent Payment Advisory Board (IPAB) which was created during the development of PPACA to reduce Medicare spending.
Subcommittee Chairman Rep. Joe Pitts reiterated earlier sentiments asserting that IPAB “is the exact opposite of transparency and accountability and merely another example of valuing centralized decision-making by government appointed experts over judgments that should be made between a doctor and patient.”
H.R. 452 has a bipartisan group of cosponsors, including members of the full committee from both sides. Reps. Frank Pallone (D-NJ) and Edolphus Towns (D-NY) joined their Republican colleagues in supporting the bill, but were determined to differentiate their rationale; “My vote in support of abolishing IPAB is not related to my support for the ACA, it is based on my belief that Congress must stop ceding legislative power to the executive branch. For me, this is about Congressional prerogatives being limited,” said Ranking member Frank Pallone.
The bill passed by a voice vote in the full committee March 6.
On Monday, House Republican leaders announced plans to introduce legislation that would extend a middle class payroll tax holiday but not include a solution to Medicare’s sustainable growth-rate formula for physicians; a measure that House Speaker John Boehner (R-OH) deemed necessary due to lack of bipartisan effort from Democrats to discuss payment for the SGR.
With the March 1st deadline for payment cuts still approaching, both parties decided the issue could not be put off any longer. Negotiations resumed, and a resolution was reached: The SGR will be paid for through a combination of bad debt payment cuts, DSH cuts and cuts to health reform’s Prevention and Public Health Fund.
GOP Conferees anticipate push-back from Tea Party members unwilling to vote for a $100 billion payroll tax cut extension without a pay-for, but Speaker Boehner has expressed confidence that he will be able to put together enough support to get the plan through.
Last week the House voted to repeal the Community Living Assistance Services and Supports program (CLASS Act). Created by the 2010 health reform law, CLASS was designed as a voluntary long-term care insurance program to give people who pay into it protection against the costs of disability. Since its inception, the legislation has been widely criticized as financially unsustainable.
House Speaker John Boehner (R-OH), said in a statement after the vote, “The president’s health care law is making it harder for small businesses to hire new workers and provide insurance for their employees, and Republicans are committed to repealing and defunding it – piece by piece if necessary.”
The legislation is unlikely to pass the Democratic-controlled Senate, however, despite assertions from the Obama administration and a letter to Congress from Health and Human Services Secretary Kathleen Sebelius indicating that the program was “not viable.”
Twenty-eight Democrats joined the unanimous Republican effort in the 267-159 vote passing H.R. 1173.
This week the Alliance of Specialty Medicine comes to Washington, DC for its annual Capitol Hill Advocacy Conference. Here, over 100 specialists, representing 100,000 doctors nationwide, will convene to further the Alliance’s goal of making sure federal health care policy fosters patient access to the highest quality of specialty care. The conference will last three days and the Alliance first gathered last night in smaller numbers as designated representatives to its Physician Advisory Council. The Council met to discuss a long range strategic plan for the Alliance and discussed legislative and regulatory priorities.
The long term strategic plan will include ways to raise the Alliance’s profile and increase its membership. The Alliance is a policy driven organization, dedicated to making sure that specialty medicine is front and center in any healthcare debate occurring in Washington. Our current roster of 11 diverse specialties representing 100,000 doctors is an already impressive number, having real firepower to make an impression on Capitol Hill. However, there are still several specialties and sub specialties out there who should really take advantage of what the Alliance has to offer.
I know the Alliance has helped NASS in its Advocacy efforts in Washington D.C., by providing the collective voice and support of a large group of physicians focused on specialty care. Through the collaborative efforts of specialty care working together we can push an agenda that meets the needs of our patients and member physician
– Raj Rao, MD
Last week, Senate Minority Leader Mitch McConnell (R-KY) introduced an amendment to the Federal Aviation Administration (FAA) reauthorization bill which would have repealed the Patient Protection and Affordable Care Act, passed last year. The amendment closely mirrored the repeal bill passed by the House in January. McConnell’s amendment, a largely symbolic attempt, failed by a vote of 47-51. All 47 Senate Republicans supported the amendment while all Democrats opposed it. Senators John Warner (D-VA) and Joe Lieberman (I-CT) did not vote.
Last week, the Senate approved a repeal of the 1099 provision originally passed as part of the PPACA. The provision requires businesses to file 1099 forms with the IRS when they purchase $600 or more in goods from another business. Senator Debbie Stabenow (D-MI) included the repeal as an amendment to the Federal Aviation Administration (FAA) reauthorization bill. The amendment passed by a vote of 87-17 but the reauthorization bill still must be passed by both the House and Senate before it can be sent to the President for his signature.
PPACA Multistate Lawsuit
Federal Judge Roger Vinson ruled last week that the health care reform law is unconstitutional, stating that the individual mandate “is outside Congress’ Commerce Clause power” and isn’t covered by the Necessary and Proper Clause. Because the various provisions to the law are intertwined, Vinson ruled that the law is void. The ruling is a victory for 26 states which brought the suit and continues a legal process that will likely be elevated to the Supreme Court by next year. The Department of Justice has appealed the ruling. Two previous rulings have upheld the law while Judge Vinson’s ruling is the second of two which have found all or part of it unconstitutional.
Health Care Reform
The House last week passed HR 2, which repeals the entire Patient Protection and Affordable Care Act which was signed into law last year. Three Democrats joined every House Republican in voting for the legislation. Republican leaders in the House allowed one Democratic amendment to the legislation which requires any committee considering replacement provisions to the reform law to include a permanent fix to the Medicare payment physician formula. The amendment, offered by Rep. Jim Matheson (D-UT), passed by a vote of 428-1, with the sole dissenter being Judiciary Committee Ranking Member John Conyers (MI-14).
House Republicans will now turn their attention to the “replace” portion of their health care agenda. Four House committees have been tasked with writing policy to replace provisions in PPACA around several broad guidelines:
- lowering health care premiums through increased competition and choice;
- providing people with pre-existing conditions better access to affordable health coverage;
- increasing the number of insured individuals;
- providing states with greater flexibility to administer Medicaid programs;
- providing seniors with assistance on prescription drug costs;
- overhauling medical malpractice laws;
- banning federal funding for abortions; and
- protecting the physician-patient relationship.
Although Senate Majority Leader Harry Reid (D-NV) announced that he would schedule the legislation for a vote in the Senate, Senate Republicans are attempting to force a vote by offering an amendment on the floor. Because Republicans hold only 47 of the 60 votes needed for passage, the legislation has almost no chance in the Senate.
Last week, the House Judiciary Committee held a hearing on medical liability reform. Three witnesses testified at the hearing: Dr. Stuart L. Weinstein, Health Coalition on Liability and Access; Joanne Doroshow, Executive Director, Center for Justice and Democracy; and Dr. Ardis Hoven, Chairwoman, American Medical Association Board of Trustees. The hearing, which was contentious at times, was called to highlight an issue that will be a priority for House Republicans during this congress. Some Democrats objected to holding the hearing at all and Republicans challenged facts and testimony provided by Joanne Doroshow, who opposes caps on noneconomic damages or additional legislation related to tort reform.
Starting this week, NASS Advocacy staff will be blogging to update you on the political landscape as it applies to NASS members and specialists. We hope you find the updates informative.
Last Monday, Treasury Secretary Tim Geithner and Health and Human Services Secretary Kathleen Sebelius wrote Senate leaders expressing support for an amendment to a small business aid package filed by Sen. Bill Nelson (D-FL) which would have altered tax reporting requirements for small businesses. Beginning in 2012, the Patient Protection and Affordable Care Act requires businesses to file 1099 forms with the IRS when they purchase $600 or more in goods from another business. The Nelson amendment sought to exempt businesses with fewer than 25 employees and raised the reporting threshold for the remaining businesses to $5,000. In the same letter, Secretaries Geithner and Sebelius expressed strong opposition to an amendment offered by Sen. Mike Johanns (R-NE) which would have repealed the 1099 provision entirely. Both amendments were defeated. The House of Representatives may revive the issue this week.
Alliance of Specialty Medicine Opposes Tax Deductions for Trial Attorneys and Seeks to Protect Quality Care
This week the Alliance of Specialty Medicine wrote Treasury Secretary Geithner last week opposing tax deductions for trial attorneys. You can see the press release here: http://www.specialtydocs.org/news/pressItem71.html
The Alliance also sent a letter to the National Commission on Fiscal Responsibility and Reform today urging significant caution related to any recommendations to cut costs which may adversely impact access to quality health care. You can see the press release here: http://www.specialtydocs.org/news/pressItem72.html