This legislation seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to nearly all Americans through government subsidies.

H.R. 3962 requires that all Americans carry health insurance coverage or face a 2.5 percent penalty tax on a portion of their income; exemptions will be made for individuals with low incomes. In addition, businesses would be subjected to provide health insurance coverage to all employees or contribute to a pool that would offer coverage. Both the individual and business mandates included in the bill will take effect in FY 2013. The bill prohibits charging individuals higher premiums or denying them coverage based on pre-existing conditions and a government-run public option would be available and operational by the Department of Health and Human Services.

The coverage expansion would be offset by raising taxes on individual incomes of $500,000 and up or $1 million and up for households. It would also cut roughly $500 billion in payments to Medicare providers. The official price tag of H.R. 3962 bill is $1.1 trillion.

Senate Hopes to Begin Health Care Debate Next Week

On Tuesday, November 10, Senate Majority Leader Harry Reid (D-Nev.) said that he hopes to begin the health care debate this week. Reid started the process of adding the House-passed bill to the official Senate calendar so he could file a motion to proceed to debate as soon as tomorrow.

Republicans are expected to mount a filibuster of the motion to proceed, which if successful would prevent the bill from being debated on the Senate floor. Reid needs 60 votes to overcome the filibuster, and has been working to secure the votes of all 60 members of the Democratic Conference.

Despite the formal calendar process, the timing of the Senate’s health care debate is still in doubt. Reid has said that he would not bring a measure to the floor without a formal cost estimate from the nonpartisan Congressional Budget Office. The CBO score is expected the week of November 16.

House to Take up Medicare Physician Payment Fix

The U.S. House of Representatives is expected to begin debate on the "Medicare Physician Payment Reform Act of 2009" (H.R. 3961) this week. The bill would stop the 21 percent Medicare physician payment cut that is scheduled for Jan. 1, 2010, and would replace the SGR formula with a new payment formula

According to H.R. 3961, the SGR would be replaced with a new formula that:

• Removes items such as drugs and laboratory services not paid directly to practitioners from spending targets
• Allows the volume of most services to grow at the rate of gross domestic product plus one percentage point per year
• Allows the volume of primary and preventive care services to grow at GDP plus two percent per year
• Encourages coordinated, innovative care by allowing accountable care organizations to be responsible for their own growth paths – irrespective of reductions or increases that apply elsewhere in the system.

Phone calls from you, your colleagues and patients are needed immediately as grassroots action is critical to the passage of this bill. Please call your representative and urge a yes vote on H.R. 3961. You can quickly and easily contact your representative by using the AMA Grassroots Hotline at (800) 833-6354. And, you can also send a follow-up e-mail via the ACR's Legislative Action Center.

According to a preliminary score from the Congressional Budget Office, the bill would cover an additional 36 million Americans and cost approximately $1 trillion dollars over the next decade – while cutting the federal deficit by $104 billion. The $1 trillion cost is offset by $740 billion in new taxes and revenue and $426 billion in cuts in spending, largely in Medicare. Democratic leaders agreed to a public insurance option using negotiated rates rather than tying rates to Medicare.

Additionally, the House bill would:

• Create an insurance market exchange, with a minimum benefit package, where individuals and small businesses could purchase coverage
• Mandate that most Americans carry health insurance and that most employers provide coverage to their workers
• Eliminate the “donut hole” for Medicare drug insurance by 2019
• Include an expansion of Medicaid to cover anyone with an income up to 150 percent of the poverty level
• Authorize insurance policies to be sold across state lines,
• and allow children to remain on their parent's insurance plans until age 27

House leaders posted the package online Tuesday, November 2. House Democrats are planning for a final vote on Saturday, November 7.

Republicans introduced their version of health care reform on Tuesday, November 2.

House Ways and Means Committee Releases Medicare Sustainable Growth Rate Legislation

On Thursday, October 29, the House Ways and Means Committee released the “Medicare Physician Payment Reform Act of 2009,” (H.R. 3961), which would repeal the 21.5 percent Medicare payment rate reduction for physician services in 2010 and replace the sustainable growth rate with a new formula.

According to H.R. 3961, the SGR would be replaced with a new formula that:

• Removes items such as drugs and laboratory services not paid directly to practitioners from spending targets
• Allows the volume of most services to grow at the rate of gross domestic product plus one percentage point per year
• Allows the volume of primary and preventive care services to grow at GDP plus two percent per year
• Encourages coordinated, innovative care by allowing accountable care organizations to be responsible for their own growth paths – irrespective of reductions or increases that apply elsewhere in the system.

The House Ways and Means Committee will add the text of the “Statutory PAYGO Act of 2009” to H.R.3961 before sending the bill to the Senate. The "pay as you go" principle of budget discipline requires Congress to pay for any new spending outside of an economic crisis.

Please call your representative and urge a yes vote on H.R. 3961. You can quickly and easily contact your representative by using the AMA Grassroots Hotline at (800) 833-6354. And, you can also send a follow-up e-mail via the ACR's Legislative Action Center.

Senate Unsure of Health Care Reform Timeline

On Tuesday, November 2, Senate Majority Leader Harry Reid (D-Nev.) wouldn’t guarantee that a health care bill would pass his chamber before the end of the year. Also, Senate Finance Chairman Max Baucus (D-Mont.) confirmed that the Congressional Budget Office would not complete its analysis of the overhaul this week. Senator Reid will use the CBO’s analysis to piece together the final Senate health care reform bill.

The time required for the CBO to analyze the Senate package, as well as upcoming holidays such as Veterans Day and Thanksgiving, are complicating Senate leadership’s goal of delivering health care reform to President Barack Obama by year’s end.

CMS Eliminates Consult Codes in 2010 Physician Fee Schedule

The Centers for Medicare and Medicaid Services’ 2010 Physician Fee Schedule will eliminate the use of consult codes as of January 2010. The ACR is working to address this issue from various angles.

The bill was projected to cost $249 billion and would have protected doctors from future scheduled Medicare cuts.

The Senate Finance bill, “America’s Healthy Future Act”, has a provision that would provide a 0.5% increase for 2010 but does not address the cuts beyond that time.

The House’s Tri-Committee bill, “American Affordable Health Choices Act of 2009” (H.R. 3200), includes a provision to permanently fix the SGR. The House is expected to address the SGR separately from health system reform in the coming weeks.

The ACR issued a “Call to Action” to the membership urging members to contact their Senators to ask for support of S. 1776. In the coming weeks, the ACR will be sending thank you letters to the 47 Senators who voted for S. 1776 and encouraging membership to contact Congress and reiterate the importance of permanently fixing Medicare’s flawed payment system.

Final Senate Health Care Reform Bill Unveiled

On Monday, October 26, Senate Majority Leader Harry Reid (D-Nev.) announced that Senate leadership had agreed on a final health care reform package. Details of the final Senate health care bill are mostly unknown. Sen. Reid stated that the legislation would include a public insurance option but would allow states to opt-out of the program. The proposal has been sent to the Congressional Budget Office for scoring. The Senate will begin debate in early November.

House Hopes to Start Health Care Debate Next Week

House leaders hope to begin floor debate on their health care reform package as early as November 2. House Democratic leaders are preparing to unveil a health care overhaul that includes a version of the public insurance option that would allow the federal government to negotiate rates with doctors and hospitals. Leaders are waiting for a more definitive score from the Congressional Budget Office on the budget impact of a public insurance option with negotiated rates before presenting the approach to the entire House. The plan with negotiated rates is estimated to save $85 billion over 10 years, less than the version linked to Medicare.

The CBO report states that the legislation would not add to the deficit but would lower it by $81 billion over the first 10 years. The bill accomplishes Chairman Max Baucus’ (D-Mont.) long-sought-after goal of delivering a bill that extends health insurance to millions of uninsured Americans for less than $1 trillion.

The Senate Finance Committee will vote on its health care bill on Tuesday, October 13.

The next phase involves merging the Finance bill with a bill passed by the Health, Education, Labor and Pensions Committee in July prior to a floor vote in the Senate.

House Leaders Will Attempt to Finalize Health Bill

House Democratic leaders are busy negotiating the details of their health care overhaul. One major sticking point is the details of a public insurance option likely to be included in the bill. This week, Democrats discussed at least three approaches to the provision: pegging reimbursement rates in the program to those in Medicare, allowing the federal government to negotiate rates with health care providers, and authorizing the provision only as a fallback option.

While tying the public insurance option to Medicare would save an estimated $85 billion through negotiated rates, moderate Blue Dog Democrats have voiced strong opposition to that approach. If House leaders decide to include a public option, they could lose the votes of many Democratic centrists and the Blue Dogs. If leaders opt to remove the public option, they could lose the votes of liberals. Even with the sizable majority of Democrats, either decision might cost enough votes to kill the bill, as Republicans appear united against it.

House leaders hope to move forward with negotiations the week of October 12.

The Finance Committee is expected to review the preliminary estimate from the Congressional Budget Office next week. The Committee could vote as early as Tuesday, October 6 on the final product.

The next phase of moving toward a floor vote on health care reform in the Senate involves merging the Finance bill with a bill passed by the Health, Education, Labor and Pensions Committee in July.

The committee sorted through a number of the 564 amendments to the chairman’s mark that were filed. A controversial amendment is expected to be debated next week when Senator Charles Schumer (D-N.Y.) will offer an amendment to replace the bill’s nonprofit health insurance cooperatives with a public insurance option. Baucus’ health care package currently includes the cooperatives as a way to garner support from moderate Democrats. Liberal Democrats favor a public option. At this time it appears that the proposal does not have the votes to pass.

The Finance Committee will merge its final bill with the Senate Health, Education, Labor and Pensions Committee bill prior to a full Senate floor vote.

House Leaders Will Attempt to Finalize Health Bill

The House Energy and Commerce Committee finished its work on their proposed health care overhaul Wednesday, September 23. The committee debated amendments that had been filed but not heard prior to the August recess. The amendments will be sent to the House Rules Committee to be added to the House’s finalized health care package.

House Democratic leaders met Friday, September 25 to negotiate the details of their health care overhaul. Speaker Nancy Pelosi (D-Calif.) will have a difficult decision on whether to include a public option in the House’s health care package. If she chooses a public option, she could lose the votes of many Democratic centrists and the Blue Dogs. If she opts to remove the public option, she could lose the votes of liberals. Even with the sizable majority of Democrats, either decision might cost enough votes to kill the bill, as Republicans appear united against it.

House leaders hope to have the basic outlines of their health care bill after Friday’s meeting.

Massachusetts Governor Names Replacement for Senate Vacancy

Democratic Governor Deval Patrick announced Thursday, September 24 that he was appointing former Democratic National Committee Chairman Paul Kirk to fill the vacancy created by the passing of Senator Ted Kennedy.

Governor Patrick signed legislation that changed state law so that an interim appointee could serve until the special election.

Kirk will be sworn in as the interim senator from Massachusetts on Friday, September 25. Kirk’s swearing in means Democrats will once again have a full caucus of 60 senators and technically a filibuster-proof majority.

The Baucus proposal would require all individuals to have health insurance, provide subsidies to help middle- and lower-income people afford private coverage, and set up marketplaces for individuals and small businesses to buy insurance at competitive rates.

Additionally the proposal would:

• Prohibit health insurers from denying coverage based on pre-existing conditions
• Prohibits health insurers from placing yearly or lifetime limits on coverage
• Replace the scheduled 21.5 percent physician fee cut with a one year 0.5 percent increase in 2010
• Create incentives for health care providers to improve quality by using safer, more cost effective health technology like electronic medical records
• Provide a 10 percent payment bonus to primary care providers
• Require all physicians to participate in PQRI by 2011 and expand the PQRI bonus through 2012

In order to pay for these reforms, the proposal would:

• Tax high premium health care plans
• Limit FSA contributions to $2,000 per year beginning in 2013
• Impose fees (beginning in 2010) on pharmaceutical manufacturers, medical device manufacturers, health insurance providers and independent clinical labs
• Impose a 0.5 percent physician fee cut to all non-primary care providers

The Finance Committee will begin its mark-up session the week of September 21. The committee will merge its bill with the Senate Health, Education, Labor and Pensions Committee bill prior to a full Senate floor vote.

ACR Members Lobby Congress on Rheumatology Issues

On September 15th, members of the government affairs committee, RheumPAC committee and ARHP advocacy committee met with members of Congress on Capitol Hill and White House health policy staff. ACR and ARHP members and staff discussed current legislative priorities during this critical time of health care reform. Participants discussed a number of key provisions while meeting with congressional members that would greatly benefit the rheumatology community if included in the overall health reform package.

These include:

• Replacing the flawed SGR formula
• Creating a loan repayment program for pediatric subspecialists
• Restoring reimbursement for osteoporosis testing
• Contacting CMS to prevent the elimination of consult codes in the 2010 Medicare Physician Fee Schedule

Each House Committee—Education and Labor, Energy and Commerce and Ways and Means—passed a version of health care reform, H.R. 3200, “America’s Affordable Health Choices Act” prior to the August recess, but the debate over the government-run public insurance option continues. House leadership continues to combine each committee’s bill before bringing it to the floor for a vote.

The Senate is awaiting legislation from the Senate Finance Committee before it can move forward with a health care reform package. The Senate Health, Education, Labor and Pensions Committee passed legislation on July 15. Majority Leader Harry Reid (D-Nev.) expressed confidence that Senate Democrats would unite and pass a health-care overhaul by Thanksgiving.

Obama Addresses Congress, Urges Passage of Health Care Reform

With Congress back in session this week, President Obama took the opportunity to address both chambers on his health care reform proposals on Wednesday, September 9. The president outlined three goals for health care reform legislation:

• To provide security and stability to those who have insurance
• To provide affordable options to those who do not have insurance
• To slow the growth of health insurance costs

Additionally the Obama proposal would:

• Prohibit health insurers from denying coverage based on pre-existing conditions
• Require insurance companies to cover routine check-ups and preventative care
• Cap a patient’s out-of-pocket expenses
• Require individuals to carry health insurance
• Require businesses to offer health insurance
• Include an option through an insurance exchange for individuals and small businesses that can not afford health insurance

President Obama spoke in favor of an option for the federal government to sell insurance in competition with private industry, but he is open to alternatives that create choices for consumers, such as an insurance co-op.

Obama also stated that he will not sign a bill that adds to the federal deficit. The president estimates that his plan can be paid for by finding savings in the current health care system – mostly by reducing waste and inefficiency in Medicare and Medicaid. He will also explore the idea of reforming medical malpractice laws to help bring down the cost of health care.

In addition to addressing Congress, the president met with moderate democratic senators Thursday, September 10 to encourage passage of health care reform this year.

Senate Finance Committee Moves Forward

Senate Finance Chairman, Max Baucus (D-Mont.), plans to introduce a health care reform bill the week of September 14, and mark-up the legislation the week of September 21 with or without bi-partisan support. The Baucus plan proposes using co-ops as a way to offer affordable health insurance which differs from the Senate Health, Education, Labor and Pensions Committee’s plan which offers a government-run public insurance option.

The Senate plans to merge the two plans before sending a bill to the floor for a vote.

Harkin To Claim HELP Committee Gavel

Senator Christopher Dodd (D-Conn.)—who was number two behind Senator Ted Kennedy (D-Mass.) of the Senate Health, Education, Labor and Pensions Committee—determined that he will remain chairman of the Senate Banking, Housing and Urban Affairs Committee.

This decision prompted Senator Tom Harkin (D-Iowa) to take the gavel of the HELP Committee, giving up the helm of the Senate Agriculture, Nutrition and Forestry Committee and prompting Senator Blanche Lincoln (D-Ark.) to take over chairmanship of that committee.

This week is your last opportunity to address health care reform before your legislators return to Washington, D.C. Schedule an in-district meeting with your senators or representative to discuss health care reform and other rheumatology issues. Locate your legislator’s contact information through the ACR’s Legislative Action Center.

View the live Webinar

Power Point Slides of the Webinar

At each event, Obama focused on the benefits his health care proposals would have on those who already have insurance and emphasized ways in which insurers can act erratically toward those who have or are seeking coverage. Additionally, the Portsmouth meeting also focused on the difficulties that those with pre-existing conditions face when seeking insurance, the Bozeman meeting focused on Americans who have lost coverage due to the development of a serious condition, and the Grand Junction meeting addressed the problem of individuals and families being saddled with huge medical bills because of a cap on their coverage.

ACR to Host Health Care Webcast

The ACR will host a webinar, "The Current State of Health Care Reform," on August 26 to provide updates as to where Congress is with the development of health care legislation. During the webinar, the ACR’s government affairs staff and its legislative consultants, Patton Boggs, LLP, will update participants on the current status of both the House and Senate legislation and will give participants the opportunity to ask questions about reform issues that are relevant to the rheumatology community.

Town Halls Focus on Health Care

Constituents from both sides of the health care debate are attending local town hall meetings in record numbers. Across the country citizens are getting involved in the health care reform discussion and so should you. August recess is the perfect time for you to reach out to your members of Congress by attending a town hall meeting or scheduling an in-district meeting. Click here* to find a town hall near you or locate your legislator’s contact information through the ACR’s Legislative Action Center.

*This site is provided as a service to ACR members and does not reflect an endorsement by the ACR.

At each event, Obama focused on the benefits his health care proposals would have on those who already have insurance and emphasized ways in which insurers can act erratically toward those who have or are seeking coverage. Additionally, the Portsmouth meeting also focused on the difficulties that those with pre-existing conditions face when seeking insurance, the Bozeman meeting focused on Americans who have lost coverage due to the development of a serious condition, and the Grand Junction meeting addressed the problem of individuals and families being saddled with huge medical bills because of a cap on their coverage.

Town Halls Focus on Health Care

Constituents from both sides of the health care debate are attending local town hall meetings in record numbers. Across the country citizens are getting involved in the health care reform discussion and so should you. August recess is the perfect time for you to reach out to your members of Congress by attending a town hall meeting or scheduling an in-district meeting. Click here* to find a town hall near you or locate your legislator’s contact information through the ACR’s Legislative Action Center.

*This site is provided as a service to ACR members and does not reflect an endorsement by the ACR.

The Senate plans to merge the Senate Finance Committee bill with the Senate Health, Education, Labor & Pensions Committee bill that was passed on July 15 before bringing the final legislation to the floor for a vote.

House Energy and Commerce Committee Has Unfinished Business

The House Energy and Commerce Committee passed its version of the “American Affordable Health Choices Act of 2009” (H.R. 3200) on Friday, July 31. However, there are still 55-60 filed amendments that were not heard before the committee passed the bill. Energy and Commerce Chairman Henry Waxman (D-Calif.) and Ranking Member Joe Barton (R-Tx.) agreed to a process that will require the committee to vote on the remaining amendments at a mark-up session when Congress returns in September. The amendments, which will be limited to those offered at the time of mark-up, will be passed out of committee and added to the larger bill in the Rules Committee.

Summer Recess is the Perfect Time to Reach out to Your Legislators

August recess is here and is the perfect time to reach out to your legislators. Many members of Congress hold town hall meetings during this time and are usually more accessible than when they are in Washington, D.C. A district meeting is a valuable tool in building relationships with your legislators. This is a great opportunity for you to discuss issues of importance to rheumatology professionals regarding health care reform. Click here* to find a town hall near you.

*This site is being provided as a service to our members and does not reflect an endorsement by the ACR.

House Energy and Commerce Committee Votes on Health Care Reform

The day before the House of Representatives adjourned for a month long recess (July 31 through September 8), the House Energy and Commerce Committee passed its version of the “American Affordable Health Choices Act of 2009” (H.R. 3200), which makes this the third House committee to pass its own version of the bill – following the House’s Education and Labor Ways and Means Committees who passed their versions July 17.

The legislation passed with a narrow margin due to many Democratic liberals opposing a deal that was cut with moderate-to-conservative Blue Dog Democrats.

The deal included both sides agreeing to the following:

• Payments in the proposed public plan option should be based on negotiated rates rather than on the Medicare fee schedule.
  
  
• States should be given the option to establish health insurance co-ops in addition to a public plan – essentially giving them the opportunity to establish their own state-based health insurance exchanges.

Additional language emphasizes that participation in the public plan would be optional for physicians.

Over the recess, House leadership plans to combine all three committee’s bills before bringing it to a vote on the floor after the recess.

Senate Finance Will Not Vote on Health Care until After August Recess

On July 30, Senate Finance Committee Chairman, Senator Max Baucus (D-Mont.), said that his committee will not vote on a health reform bill before adjourning for summer recess on Friday, August 7.

Negotiations will continue in the Senate Finance Committee among a bipartisan group of six Senators that includes Chairman Baucus, Ranking Member Chuck Grassley (R-Iowa), and Senators Kent Conrad (D-N.D.), Jeff Bingaman (D-N.M.), Olympia Snowe (R-Maine) and Mike Enzi (R-Wyo.). The group is aiming to reach an agreement by September 15.

The Senate Health, Education, Labor & Pensions Committee passed its version of health care reform on July 15, and the Senate plans to merge its Finance and HELP Committees’ bills before sending the finalized legislation to the floor for a vote.

The Senate plans to merge the Senate Finance and HELP Committees’ bills before sending the finalized legislation to the floor for a vote. The Senate Health, Education, Labor & Pensions Committee passed its version of health care reform on July 15.

President Addresses the Nation on Health Care Reform

President Obama held a primetime news conference on Wednesday, July 22, that focused almost exclusively on health care. For the first time, the President verbally supported a new tax that would raise income taxes on families earning more than $1 million a year. However, he firmly stated that he is opposed to any health reform legislation that is primarily funded through taxing middle-class families. During his address, Obama continuously argued that his proposals would reduce the federal deficit because they would be fully paid for and would slow the rate of increase in health care costs.

Additionally, Obama countered accusations that his plan would eventually cause people to lose their private insurance. Critics have voiced that the public plan would eliminate the private health insurance market and force people into the government-run plan; however, Obama argued that the competition from a government insurer would force private insurers to improve their plans and reasserted that people who are happy with their current insurance will be able to keep it.

Debate Continues in the House

Concerns over H.R. 3200, “America’s Affordable Health Choices Act,” have emerged from centrists in both parties, including the fiscally conservative Democratic Blue Dogs, Republican senators and representatives, and others. Many of the centrists are concerned that the legislation proposed so far is too expensive, does not sufficiently reduce long-term health care costs, and raises taxes too high. Because of these shared concerns, these groups oppose the current legislation.

House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) spent time on Wednesday, July 22, negotiating with the Blue Dogs. Waxman noted that Democrats were close to an agreement, but the Blue Dogs offered a different view – asserting that little progress had been made. While the Energy & Commerce Committee’s markup* was delayed again on Thursday, the House Ways and Means Committee continued its mark up this week. The House Education and Labor Committee passed H.R. 3200 on July 17.

Speaker of the House Nancy Pelosi, (D-Calif.) stated that the House will go home for August recess without passing H.R. 3200. The House will resume work on health care reform in September.

*Definition of mark up: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation.

ACR White Paper

SFC Delivery System

ACR Response paper 1

SFC Policy Option on Health Care Coverage

ACR Response paper 2

SFC Final - paper 3

• Transforming the Health Care Delivery System: Proposal to Improve Patient Access to Care and Reduce Health Care Costs ACR Comments
• Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans ACR Comments
• Financing Comprehensive Health Care Reform: Proposed Health Savings and Revenue Options

In The News

Industry groups pledge 2 trillion in health savings.

On May 11, President Obama announced that health-care companies and various related groups have pledged to slow projected spending growth by 1.5 percent a year over the next decade. Overall, this will lower U.S. medical costs by about 2.1 trillion dollars. These groups represent drug makers, health insurers, hospitals, labor representatives, medical device makers and physicians throughout the United States. The groups' commitment to reduce health care spending could result in a 20 percent reduction in the projected rate of increase by 2019. This move could save a family of four an annual average of $2,500 within five years. Under the current structure, health-care spending is set to rise at a rate of 6.2 percent in the next ten years. This pledge was endorsed by the American Medical Association, the American Hospital Association, Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America’s Insurance Plans and the Service Employees International Union.

Supporting Materials

ACR White Paper

SFC Delivery System (Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs)

ACR Response paper 1

SFC Policy Option on Health Care Coverage (Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans)

ACR Response paper 2

SFC Final - paper 3 (Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options)