On Health Care Reform, a Major Step Remains

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Wednesday, March 24, 2010 at 6:00 am
President Obama signs the health care reform bill on Tuesday. (ete Marovich/ZUMApress.com)

President Obama signs the health care reform bill on Tuesday. (Pete Marovich/ZUMApress.com)

With President Obama having signed an enormous, $938 billion health reform proposal into law Tuesday, it’s tempting to imagine that the long-drawn and ubiquitous debate over health care legislation is over for a while.

If only it were so.

[Congress1] Neither the bill that was signed yesterday nor the accompanying reconciliation proposal moving through the Senate this week addresses the flawed formula that dictates physician payments under Medicare — one of the most agonizing and expensive problems facing the entire health delivery system. The omission has left doctors facing a 21-percent cut in their Medicare payments at the end of the month; it’s threatened Medicare patients with access-to-care problems; and it’s inspired the powerful doctors lobby to undertake an all-out blitz in search of a permanent formula fix. It’s also put Democratic leaders in the odd position of celebrating the historic significance of their health care overhaul, while at once plotting a strategy to prevent doctors from suffering huge cuts not addressed by those reforms.

At issue is the 13-year-old formula — the so-called Sustainable Growth Rate (SGR) — that was designed to prevent Medicare doctor payments from skyrocketing by indexing reimbursements to the growth of the economy on the whole. Trouble is, health care inflation has grown by degrees faster than GDP in recent years. Indeed, the SGR has called for cuts in doctors’ Medicare pay every year beginning in 2002. That’s a perennial thorn in the side of Congress, which, having no stomach for alienating the powerful physician lobby, almost always steps in with a temporary fix.

This year, though, the temporary fix also threatens to alienate the AMA.

“The AMA cannot support proposals that aim to address only the most imminent threat to payments levels and patient access, with no regard for the future of the Medicare [program],” AMA President James Rohack wrote to Senate leaders earlier this month. “We are opposed to further short-term patches of any duration.”

Lawmakers on both sides of the aisle are well aware of the problem. Speaking to reporters at the Capitol last Friday, House Speaker Nancy Pelosi (D-Calif.) said that a permanent doc-fix remains “very important” to Democrats. “It’s not in this bill, but we will have it soon,” Pelosi said. “We have made a commitment to do this.”

The issue is hardly partisan, nor will it have any effect on the larger reform bills recently passed by the Democrats. But the fix doesn’t come cheap. Indeed, a bill passed by the House in November would scrap the SGR altogether, replacing it with a formula designed to ensure that doctors’ Medicare payments reflect the true cost of delivering care. Pricetag: $210 billion.

It was that cost — which wasn’t offset with new revenues or cuts elsewhere — that caused the budget hawks of the Senate to shoot down a similar proposal a month earlier. And it was that cost that caused Democrats — who’d vowed both to keep their reform package below $1 trillion and to offset the entire tab — to strip the doc fix from the larger reform bills.

The issue has left Democrats in a pickle: In an election year, they don’t want to alienate the AMA. But with voters already weary of deficit spending, nor can they borrow another $210 billion to fund a permanent fix.

“Any way you look at it, I don’t see how they get 60 votes [in the Senate],” said Julius Hobson, former AMA lobbyist and now a senior policy analyst at the Washington law firm Bryan Cave.

Lawmakers don’t have much time. On April 1, Medicare payments to doctors are scheduled to fall, on average, by 21 percent. Both the House and Senate have recently passed bills to delay the cut temporarily — the House by one month and the Senate by seven months. But when Senate Democrats tried Friday to adopt the House bill by unanimous consent, Republicans refused.

A spokeswoman for Senate Majority Leader Harry Reid (D-Nev.) said Tuesday that Democrats will likely try that strategy again this week, after they’ve finished the debate over the health reconciliation bill. Complicating matters, Congress is scheduled to leave Friday for spring recess, and won’t return to Washington until April 13. That timetable leaves open the possibility that Congress would have to tackle the 21-percent cut retroactively — an uncertainty that’s been a thorn in the side of doctors trying to manage their businesses.

“For the physicians in actual practice,” Hobson said, “this is a nightmare.”

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Comment posted March 24, 2010 @ 10:51 pm

PRESIDENT OBAMA'S HEALTHCARE LEGISLATION WILL SAVE THOUSANDS OF INNOCENT AMERICAN LIVES & GOVERNOR RICK PERRY OF TEXAS IS STILL PONDERING TO DEMAND DNA TESTING ON A POSSIBLE INNOCENT MAN NAMED HANK SKINNER WHO WILL BE POSSIBLY FALSELY EXECUTED ???

*** PRESIDENT BUSH WHEN GOVERNOR OF TEXAS HAD THE GODLY SPIRIT TO DEMAND DNA TESTING PRIOR EXECUTING A POSSIBLE INNOCENT DEATH ROW PRISON INMATE GOVERNOR PERRY !!!

TEXAS GOVERNOR RICK PERRY PLAYS HARI~KARI WITH GOD OR ORDERS DNA TESTING ON THE WALKING DEAD ???

GOVERNOR RICK PERRY OF TEXAS NEEDS TO CALL THE TERMINATOR GOVERNOR OF CALIFORNIA ABOUT DNA TESTING,GIRLY MEN AND POLITICAL HARI~KARI …..

ARNOLD,WILL YOUR FELLOW REPUBLICAN GOVERNOR RICK PERRY OF TEXAS PLAY POLITICAL HARI~KARI & BECOME SATANS TEXAS TERMINATOR IN DECIDING THAT ONLY GIRLY MEN NEED DNA TESTING BEFORE THEIR POSSIBLE WRONGFUL EXECUTION ???

Texas death row inmate's final request: DNA testing. His odds look poor, but a murder convict hopes the Supreme Court makes Texas put off his execution. March 19, 2010|By David G. Savage Reporting from Washington (LA TIMES) — Texas death row inmate Hank Skinner, convicted of murdering his girlfriend and her two sons 16 years ago, has only one request before he is executed next week.

He says the state should be required to do DNA tests of evidence from the victim, such as semen and blood under her fingernails, that could prove, once and for all, who was the real killer. His lawyers do not say they are certain he is innocent. They are certain, however, that no one should be put to death without testing crucial evidence that could show the wrong man was convicted.
AdvertisementSkinner has asked the U.S. Supreme Court to block the execution, set for Wednesday, to permit time for the testing.

Skinner was an obvious suspect in the murder of Twila Busby on New Year's Eve 1993. He had been drunk and asleep on her couch shortly before she was strangled and clubbed to death in the same room. Her blood as well as that of one of her dead sons was found on his clothes. Skinner insists he awoke in a stupor to find his girlfriend murdered, and he maintains that her uncle was the killer.

“The state of Texas is trying to kill me for something I didn't do,” Skinner said in a recent taped interview from prison. “We are asking to test all the evidence they identified as important.”

Skinner left a trail of blood as he staggered from Busby's house in the north Texas town of Pampa. He said he had cut his hand on a broken bottle when he fell off the couch, and his bloody palm prints were found near the victims.

But police and prosecutors did not test other evidence from the crime scene, including a vaginal swab from the victim and her fingernail clippings. It appeared as though she had been raped and struggled with her killer.

Busby had left a New Year's Eve party before midnight after her drunken uncle made rude sexual advances.

Two bloody knives also went untested, even though her 20- and 22-year-old sons had been stabbed to death. Skinner's appointed defense lawyer could have had this evidence tested prior to the trial, but he did not do so.

“In any investigation today, all of this evidence would have been tested for DNA,” said Rob Owen, a University of Texas law professor who now represents Skinner. “But why not do the testing now?”

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cdubose
Comment posted March 27, 2010 @ 2:16 am

Here we have the first incident of rationing of care. What is the cheapest, most effective way to cut health care costs? Make it impossible for physicians to see patients. With a 21% cut in reimbursement, physicians will be forced to not see medicare patients. It will cost them more to treat a patient than what they will be reimbursed. Hence, no more medicare patients treated, lower costs to the government – there you go. Efficient, fast and effective rationing of care, and it is shameful.


Myview
Comment posted March 28, 2010 @ 4:09 pm

I hope this helps some of you looking for work. I found the website http:federaljobs.net/irsagent.htm if you want to read on how/when to apply for these new jobs. The IRS is hiring it says “more than 17,000 new IRS Agents to enforce the new Health Care legistlation “. The job pays, it reads, “The average annual salary exceeds $42,000 a year for IRS agents” which is not a bad salary. I didn't read what benefits the job offers, should be the usual government benefits. These new IRS agents I read will be in charge of collecting the fine/penalty we pay if we don't buy a health insurance policy.


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Great post, thanks for sharing it with us. I'll read the rest now.


gfstiel
Comment posted April 7, 2010 @ 4:58 am

Maybe the AMA should have thought of this before they were so anxious to jump under the bus and support the health care bill. Now they should live with what they asked for just like the rest of us are going to have to live with this terrible law..


Myview
Comment posted April 9, 2010 @ 7:14 pm

For those of you who don't know, employers are going to be required to report employees insurance coverage cost on employee's W-2 Form to the IRS. I’ve been reading the Health Care Bill at the Library of Congress and at the Senate.

For the Library of Congress go to http://thomas.loc.gov/ H.R.3590 Patient Protection and Affordable Care Act Subtitle F-Shared Responsibility for Health Care Sec. 1501. Sec. 1502 deals with penalty and IRS is required to send out notices to those without health insurance coverage to inform of the Exchange pools and Title IX: Revenue Provisions – Subtitle A Sec.9002 Requires employers to disclose on employee W-2 Form to the IRS the cost of health insurance policy from employer to employee. H.R.3200 America’s Affordable Health Choices Act of 2009 informs of imposing a Tax on individuals without an insurance policy and to employers not offering an insurance policy. Taxpayers are also required to inform the IRS of their health insurance policy in their Income Tax Return.

For the Senate go to http://dpc.senate.gov/healthreformbill/healthbi… Subtitle F-Shared Responsibility for Health Care Sec. 1501. Sec. 5000A. discusses the penalty to those without an insurance policy and Sec. 1502. and Sec. 6055. deals with reporting health insurance coverage to the IRS. Subtitle A-Revenue Offset Provisions Sec. 9002. Employer to report insurance coverage on employee W-2 Form to IRS.
Title IX-Revenue Provisions – Subtitle A-Revenue Offset Provisions Sec. 9002 deals with reporting cost of employer health coverage on employee W-2 Form.

The correct website address for the IRS agent jobs to enforce the Health Care is http://federaljobs.net/irsagent.htm


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