Congressional Democratic leaders are weighing their next steps on health reform legislation, following Republican Scott Brown's upset victory in last week's Massachusetts Senate race.
Brown's victory over Democrat Martha Coakley will deprive Senate Democrats of the 60-vote supermajority they need to prevent a Republican filibuster of a compromise reform bill. In the wake of his victory, the White House and congressional Democratic leaders have put a hold on talks about merging the House and Senate bills.
Congressional Democratic leaders are pondering several options for moving reform forward. One option is for the House to simply approve the bill that cleared the Senate on Christmas Eve. But a number of House Democrats have voiced numerous concerns with the Senate bill.
Under another option, Congress could pass a slimmed-down version of reform legislation through a fast-track budget procedure known as reconciliation. Such measures only need 51 votes to pass, but rules limit their contents to provisions that affect the federal budget. Or Congress could revert to a bare-bones measure that would include some of the most popular initiatives in the current bills.
As congressional Democrats weighed those options, hospital and health system leaders last week delivered a unified hospital message to lawmakers on key elements of health reform, like coverage, Medicaid expansion, a public health plan and Medicare readmissions. They participated in a Jan. 20 "Hospital National Call-In Day" by calling a toll-free phone number that connected them to their legislators on Capitol Hill.
The national grassroots initiative came nearly two weeks after the AHA sent a 27-page letter to House Speaker Nancy Pelosi, D-CA, and Senate Majority Leader Harry Reid, D-NV, outlining the hospital field's concerns with the House and Senate reform bills and suggestions for what should be included in final legislation. For information on the letter, AHA members should go to "Health Reform Update" at www.aha.org.
In other news, 104 House lawmakers recently urged Pelosi to ensure that the final bill does not lower Medicaid and Medicare disproportionate-share hospital (DSH) payments more than in the House-passed bill. The House bill would cut Medicaid and Medicare DSH payments by $10 billion each over 10 years, while the Senate bill would cut Medicaid DSH by $18.5 billion and Medicare DSH by $24.4 billion.
"To retain our health care safety net's stability, we believe that future DSH payments must continue to recognize financial losses sustained by these providers due to Medicaid reimbursement shortfalls and uncompensated care," the representatives wrote in a Jan. 14 letter to Pelosi. The AHA-supported letter was organized by Reps. Silvestre Reyes, D-TX, John Lewis, D-GA, and Jan Schakowsky, D-IL.
In other reform developments, nearly 75 health care organizations, including the AHA, recently urged congressional leaders to exclude a proposed Independent Payment Advisory Board (IPAB) from the final health care reform bill.
The Senate proposes the independent Medicare commission to determine payment policies for the program. The commission could recommend ways to curb the growth in Medicare spending, and its recommendations would take effect unless Congress blocks them.
Although the hospital field would be exempt from the commission's recommendations through 2019, the AHA has concerns about the board minimizing Congress' role in ensuring adequate Medicare payment policy.
In the letter to Capitol Hill, the health care groups noted that the board "would be required to make recommendations to reduce per capita Medicare spending regardless of whether it was growing faster than general health care inflation."
They added that the reductions would be on top of the $400 billion to 500 billion in savings from provider payments that already are included in reform legislation. These additional reductions "could jeopardize both access for Medicare beneficiaries and even infrastructure for the entire health care system," the groups wrote congressional leaders. The groups favor responsible containment of rising health care costs, but called the IPAB an ill-advised proposal that "usurps congressional authority over the Medicare program."
