Editor: Randy
Revelle
Volume 9, No. 6
October 12, 2009
Senate Finance
Vote Set
After a summer of anticipating
the Senate Finance
Committee’s health care reform proposal, Chairman Baucus released a
conceptual “mark” in mid-September with the bill’s actual language
scheduled for publication later this week. A committee vote is
set for Tuesday,
October 13, 2009, and the bill is expected to pass along a party-line
vote. The Senate Finance Committee wrapped up its amendment
process on Friday, October 2, but delayed voting until the
Congressional Budget Office’s (CBO's) score of the latest version of
the
America’s Healthy Future Act was released. According to the CBO,
the
legislation will cost about $829
billion over 10 years,
is fully paid
for with offsets and taxes, and reduces the federal deficit by $81
billion.
The bill expands health
insurance to millions of Americans – 91 percent
will be insured – yet 25 million people will remain without health
insurance. After the Finance Committee’s vote, the next step is
for the Senate Finance and the Health, Education, Labor, and Pensions
Committee to iron out the differences between their two bills and
present a single bill for a full vote of the Senate. Many
Senators, including Democrats and Republicans, said much more work
remains before they
could support the bill on the Senate floor.
Federal
Dollars for Basic Health
Washington State Senator
Maria Cantwell, a member of the Finance
Committee, worked to improve the original America’s Healthy Future Act
by offering
two amendments. Both proposals were adopted by the committee.
Senator Cantwell’s amendment,
if enacted by Congress, would provide
federal dollars to fund the state’s Basic Health Plan. Beginning
on July 1, 2013, the Basic Health
Plan would be available to individuals in participating states whose
incomes are between 133
and 200 percent of the federal poverty level, roughly equal to $14,400
to $21,660 annually for a single individual in today’s dollars.
The
federal government would fund the program based on the calculated value
of individual tax credits and cost sharing subsidies for eligible
individuals in the state. Of those tax credits and subsidies
identified, 85 percent would be distributed to states choosing to
create Basic Health Plans. The federal dollars could only
be used to fund the Basic Health Plan. To help avoid
cost-shifting to a
state’s plan, enrollees must meet the following criteria:
- Are under the age of 65;
- Do not have access to affordable employer sponsored coverage that
meets minimum credible coverage standards;
- Are residents of an area served by the plan;
- Choose to obtain basic health care coverage from a participating
health care plan;
- Remain current in payment of their share of the premiums.
The Washington State Hospital
Association (WSHA) supports this approach to
funding the Basic Health Plan, while
providing lower income people with access to affordable health care
options. The expansion of the Basic Health Plan is consistent
with WSHA's health care reform
principles.
Value Based
Physician Payments
Senator Cantwell also offered
an
amendment to change the way physicians
are paid to include a separate modifier. The
payment modifier will, in a budget-neutral manner, pay physicians or
groups of physicians differentially based upon the quality of
care they achieve for Medicare beneficiaries relative to
cost. Costs
shall be based upon
a composite of appropriate measures that take into account justifiable
differences in input practice costs, demographic
characteristics, and the baseline health status of Medicare
beneficiaries served by a physician or groups of physicians.
Quality
measures will include risk-based measures that reflect health outcomes
and the health status of beneficiaries.
The U.S. Secretary of Health
and
Human Services would publish measures by
January 1, 2012 and would begin implementation in 2014. By 2017,
all fee-for-service physician payments would be subject to the modifier.
WSHA supports including
quality
and cost measures in physician payments. The Washington
State Medical
Association also supports Senator Cantwell's approach.
Summary
There is no assurance that
Senator Cantwell’s amendments will remain in
the final health care reform package offered to the full Senate.
The
bills will continue to change over the next several weeks as the Senate
struggles to find 60 votes to move a
bill to the floor. The
House of Representatives is in the process of melding its three
versions of health care reform in preparation for a full membership
vote. The House may wait until the Senate has
developed a final proposal before moving forward on their floor
vote. One of the main controversial differences between the two
bodies is how to expand insurance coverage. The Senate includes
nonprofit cooperatives as its model, while the House has included a
government run public option, which would pay hospitals negotiated
rates set somewhere between Medicare and private plan rates. The
American Hospital Association has been on record supporting the Senate
Finance approach, though they are currently not pleased with the health
insurance coverage estimate of 91 percent.
If you have questions about
these articles, please contact Chelene
Whiteaker at chelenew@wsha.org
or 206-216-2545.
Washington
State Hospital Association
300 Elliott Avenue West, Suite 300, Seattle, WA 98119-4118
Phone: (206) 281-7211, Fax: (206) 283-6122, Web Site: www.wsha.org
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