The House put out a preview of its vision for reform — Henry Waxman’s hand looms heavy in the authoring this tri-committee health care reform collaboration among Waxman (Energy and Commerce), Charles Rangel (Ways and Means) and George Miller (Education and Labor). House Speaker Nancy Pelosi’s hand is also in there somewhere. Pete Stark (Ways and Means Health Subcommittee Chair) is baaaaaack from medical leave. He’s engaged in SGRrrr relief this week. The House has not tried to create a radical departure from how the Senate proposals are shaping up, which bodes well for something to ultimately pass Congress this summer.

Comparing and Contrasting with the Senate
There are a few differences between House and Senate versions, but the similarities are what’s more striking:

• Insurance reform to eliminate underwriting and excessive profits
• Universal coverage/access via both continued employer coverage and an individual mandate with subsidies for low-income families not covered by employers
• A public insurance plan to compete with private insurers
• Purchasing cooperatives
  
• Loosely defined strategies for reducing costs of care and improving quality
• A notion of “accountable care organizations” to go along with payment reforms
• Promotion of the "medical home"
  
• Primary care, nurses, and team practice and workforce scholarships.

Employers that don’t provide coverage would get taxed (pay or play); and Medicare Advantage insurance plans get cuts. But, the payment reforms and big payment increases may not be for everybody — likely only for the integrated system types.

The House proposes to pay for reform with the same menu of options discussed by the Senate and the White House already. Taxing fat cat health insurance premiums above a median average premium cost is still on the table. The House also acknowledges there need to be more cuts  ($300 Billion worth) from health care somewhere to actually finance expanded access, which could put physicians at risk (imaging is again being discussed as a place to cut).

Senate, White House Updates
The Senate HELP Committee got its language out. We outlined that last week and will give you a link to that if you’re interested as well. It’s only 600 pages long. A great book to read, but a lot of folks may be waiting for the movie. The Senate Finance Committee is still working on its language details, but it’s getting closer to being published before “mark-up,” and will come out in a week or so.

The White House has been involved with all these committees to make sure things keep moving in parallel with them. The President’s having meetings every day with committee chairs and various constituency leaders to move the issue forward. His Wisconsin town hall promoted keeping the ‘public plan’ in the mix to keep insurers competitively priced. Obama also spoke earlier today at the AMA's meeting about the need for reform and why doctors should support his efforts. See an AP video on the meeting below, and check out ACC's statement.

Next steps
All Senate and House committees are on track to mark up their bills during July, and we appear to be heading for the introduction of both Senate and House bills before the August recess. The Conference Committees would then begin to deliberate a final bill in September. We need to start educating members about what the implications of these bills will be on cardiology -- that is, once we’ve got all the proposed language in front of us. But things could get stalled too -- like over the public plan.

The (Divisive) Public Plan
We were asked this week by four major media sources what ACC thinks about the ‘public plan,’ particularly since AMA allegedly trashed it (I don’t think they really did, but that’s how their comments were interpreted). Not having explicit policy, what we’ve been saying is:

The public plan is a legitimate issue to consider, with pros and cons; but, given that the specifics are unspecified, we have no position yet. However, ACC wants the nation to move forward and expand access and coverage to all Americans, and also use the momentum of reform to fix the SGR, to improve quality of care, and to institute payment reforms that promote quality and effectiveness. These are the key things Americans need. To derail reform over the controversies surrounding public plan as a single provision is irresponsible. If that issue that takes longer to resolve, so be it. But let’s not let one divisive issue otherwise hold back major needed reforms.

I'll be talking about these new developments in greater detail in coming weeks. Try to stay tuned.

[youtuber youtube='http://www.youtube.com/watch?v=NVipJD0WM44']

< Back to Listings