The 110th United State Congress has begun work on a number of issues of importance to the osteopathic family medical practitioners. Read about the issues the new Congress will address.
Medicare Physician Payment The need for comprehensive reform of the Medicare physician payment formula remains a focal point for many Members of Congress. However, the complexity of the issue and the costs associated with such legislation remain obstacles to reforms. The current cost estimate of eliminating the sustainable growth rate formula now tops $230 billion over 10 years.
Medical Liability Reform House Judiciary Committee Chairman John Conyers (D-MI) strongly opposes reforms such as those included in the Help Efficient, Accessible Low-cost, Timely Healthcare (HEALTH) Act approved by the House in the 107th, 108th, and 109th Congresses. Senate Judiciary Chairman Patrick Leahy (D-VT) also strongly opposes reforms proposed by the Republican members of the Senate. Both Chairmen proposed medical liability reform legislation in the past that focused on insurance reforms. Time permitting, Chairmen Conyers and Leahy may make an effort to review current laws regulating medical liability insurance companies.
Graduate Medical Education This issue could receive stronger interest in the 110th Congress. Historically, Republicans were not supportive of expanding the graduate medical education program within the Medicare Trust Fund. This was especially true during the past six years during the Ways and Means Chairmanship of Bill Thomas (R-CA). Democratic control of the Ways and Means and Finance Committees will move this issue, at minimum, to the neutral position — which may lead to legislation.
Access to Health Care and the Uninsured This issue will move to the front of the Congressional debate, but the prospect for any meaningful reforms remains unclear. While much has been done over the past few years on the state level, Congress failed to advance the debate beyond the consumer-driven health care concepts implemented in the Medicare Modernization Act — mainly health savings accounts. Incoming HELP Committee Chairman Edward Kennedy (D-MA) renewed his call for the creation of the “Medicare for All” health care system, where individuals could buy-in to the Medicare program. The cost of the program is estimated to be $600 billion per year — making it unlikely to secure Congressional support. However, the concepts included in the proposal will receive significant attention on a provision-by-provision basis.
Medicare Prescription Drug Benefit The Medicare prescription drug benefit likely will avoid major overhaul in the 110th Congress due to a relatively high degree of satisfaction among beneficiaries. Democrats will be wary of taking on complicated Medicare issues leading up to the 2008 Presidential elections. However, Democrats will seek to alter the program in two major areas – negotiation authority and “filling” the donut hole.
Managed Care Reform Democrats likely will revive their “Patients Bill of Rights” from the 106th and 107th Congresses. While the name will remain, the focus of the legislation will shift from the commercial insurance market to the Medicare Advantage plans. Chairmen Stark and Dingell announced plans to examine payments policies established by the Medicare Modernization Act (MMA) for Medicare Advantage plans. The ACOFP strongly supported managed care reform legislation in the past, and will be pressed to do so again in the 110th Congress.
Education & Student Loan Financing Democrats pledged to reform the Nation’s student loan programs and reduce the interest rates on Federal loan programs in their first 100 hours of control. They also pledged to increase the amount available under the Pell Grant program.
Quality Reporting and Pay-for-Performance Several Democratic members raised concerns about the establishment of quality-reporting and pay-for-performance systems. However, Finance Committee Chairman Max Baucus (D-MT) introduced legislation that would establish such a system in the 109th Congress, and remains a strong supporter of such programs. This issue may lose some momentum, but it will not disappear.
Health Information Technology Congress will continue to pursue the enactment of legislation that establishes a comprehensive interoperable health information system. This will remain a bipartisan issue in the 110th Congress.
National Institutes of Health The National Institutes of Health (NIH) will benefit from Democratic control of Congress. The NIH has enjoyed strong bipartisan support over the past decade. Republican Congress fulfilled a pledge to double the NIH budget. In recent years, some in the science community have complained that increases in NIH funding have not kept pace with inflation, while Republicans have complained that the NIH has not been reauthorized as required by law. It remains unclear if Democrats will attempt to reauthorize the NIH, but the NIH should see increases in funding over the next two years.
Title VII Programs Health professions programs funded by Title VII should receive stronger support in the 110th Congress. Democrats are strong supporters of these programs and advocated for higher funding for the past few years. We do face challenges in this area, however. Democrats have strong ties to the non-physician community, and may use their Chairmanships to advocate for expanding access to these funds for non-physician groups — especially nurse practitioners and chiropractors.
Rural Health Rural health will benefit from a Democratic Congress due to an interest in expanding access to health care. The Senate Finance and House Ways and Means Committees contain a large number of rural Members expected to advocate for increases in funding for rural health care providers. A top priority will be reform of the geographic practice cost indices used in Medicare financing. Rural hospitals also may see increased funding. Again, this may equate to a larger focus on non-physician providers.
Consumer-Driven Health Care This issue will receive less attention in the 110th Congress. In general, Democrats are less supportive of consumer-driven principles. Democrats are hesitant to support these models due to their view that they benefit the healthy and wealthy, and serve as a tax shelter versus a health care program. Additionally, Democrats expressed strong opposition to the availability of health savings accounts in Federal health care programs such as the Federal Employees Health Benefits Program (FEBHP). It is unlikely that they will attempt to revoke health savings accounts, but they will not expand tax provisions that benefit these programs. Republicans and the House Democrat Blue Dog Coalition likely will push additional tax provisions that strengthen health savings accounts.
Specialty Hospitals This issue divides the Democratic caucus. Many Democrats support the establishment of specialty hospitals, due to their opinion that it improves quality and reduces costs. Others oppose specialty hospitals because they claim that such institutions limit access to services for poor and underserved communities.
Genetic Nondiscrimination Both the House and Senate should approve genetic nondiscrimination legislation early in the 110th Congress. The issue continues to have strong bipartisan, bicameral support. In the 109th Congress, the Senate approved the “Genetic Information Nondiscrimination Act of 2005” by a vote of 98-0. The House version of the bill secured 230 co-sponsors, but was not allowed floor consideration by the House Republican leadership.
Mental Health Parity Mental health parity legislation faces improved odds, but it is not a given that a bill will be approved by this Congress. The issue of requiring parity in coverage between physical and mental health care services is broadly supported, but the costs of such coverage raises concerns among lawmakers. Parity has strong champions in Senators Edward Kennedy (D-MA) and Pete Dominici (R-NM), and by Representatives Patrick Kennedy (D-RI) and incoming Speaker Nancy Pelosi (D-CA).
