The Senate resumes debate this week on health care reform legislation, the “Patient Protection and Affordable Care Act,” H.R. 3590, with amendments expected to be offered to alter the bill's public option and Medicare commission.
Senators only considered a handful of amendments last week. But talks this week are expected to intensify on a public option “compromise,” and amendments may be offered by Sens. Tom Carper, D-DE, and others as alternatives to Senate Majority Leader Harry Reid’s, DNV, proposal for a public plan with a state “opt-out” clause.
Reid’s plan would create a new government-run insurance plan, or public option, to compete with private insurers in new insurance marketplaces called exchanges.
The insurance exchanges would go into operation in 2014. Under Reid’s public option, states would have to pass a law to withdraw from the program.
Carper recently suggested a public option that would kick in for states when insurance companies fail to meet standards of availability and affordability of plans. Carper has said that Reid’s public option opt-out lacks the 60 filibuster-proof Senate votes needed for passage.
The AHA has serious concerns about the public option, and favors another approach that is contained in the legislation: nongovernment, non-profit insurance cooperatives that pay providers negotiated rates.
In addition to proposals to modify Reid‘s public option, amendments may be offered this week to include hospitals within the authority of the Medicare commission set up under the bill. The commission would determine payment policies for Medicare. It could recommend ways to curb the program’s growth, and those recommendations would take effect unless Congress blocks them. The bill currently exempts the hospital field from the commission’s recommendations through 2019.
The AHA last week said hospitals already face significant Medicare and Medicaid spending reductions under the bill, and can’t afford the additional cuts that could result from the Medicare commission’s policies.
Another key hospital concern is with the coverage numbers in H.R. 3590. The legislation would extend coverage to 94% of all legal U.S. residents, leaving 24 million people uninsured. The bill falls short of the hospital field’s agreement earlier this year with Senate Finance Committee Chairman Max Baucus, D-MT, and the White House to $155 billion in Medicare and Medicaid reductions as hospitals’ portion of the shared responsibility needed to fund the expansion of coverage. The agreement stipulated that coverage would be expanded to 97% of all those legally residing in the United States.
“Senators should increase the number of people who would receive coverage under the bill,” said AHA Executive Vice President Rick Pollack. “If that does not occur, then the Senate should lower the hospital payment reductions that are included in the bill.”
If the bill does not expand coverage further, the AHA said it will seek changes that scale back proposed cuts to Medicare patient readmissions, the Medicare and Medicaid disproportionate-share hospital programs and Medicare’s annual hospital market basket updates.
The AHA observed that the Finance Committee’s bill contained a readmissions policy that targeted only avoidable readmissions. But the association faulted Reid’s proposal for being overly aggressive and failing to discriminate between avoidable and unplanned hospital readmissions that are unrelated to the patient’s initial admission to the hospital.
In a Nov. 23 “Advocacy Alert,” the AHA encouraged hospital leaders to contact their senators and raise their concerns about the legislation. AHA members can find the alert under “Health Reform Update” at www.aha.org.
Democratic leaders vow to finish the bill before the end of the year. That’s a tall order, given the fast-closing legislative window.
But Senate Majority Leader Harry Reid, D-NV, is threatening to keep the Senate in session through Christmas and New Year’s Day and to employ rarely used procedural tactics to hold the necessary votes for passage.
