Washington Highlights: October 30,
2009
House Democrats Unveil $894 Billion Health Care
Reform Legislation
Contents
Prior Issues
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House Democratic leaders Oct. 29 released an $894 billion health
care reform package that is expected to expand coverage to an additional 36 million
individuals. The Affordable Health Care for America Act (H.R.
3962) is largely a merged version of legislation passed earlier
this year by the three House committees with jurisdiction over health
care reform (Ways and Means, Energy and Commerce, and Education
and Labor).
The nearly 2000-page bill establishes an individual insurance mandate
and significantly expands Medicaid eligibility. It includes a public
health insurance option that would reimburse providers using negotiated
rates. According to the Congressional Budget Office (CBO), the cost of H.R. 3962 is partly offset by $426 billion in reductions to Medicare,
Medicaid, and other federal health programs. The legislation does
not include provisions to avert the scheduled 21.5 percent reduction
in 2010 Medicare physician payment updates.
At a rally to unveil H.R. 3962, Speaker Nancy Pelosi (D-Calif.)
stated that "the drive for health care reform is moving forward."
According to Rules Committee Chair Louise Slaughter (D-N.Y.), the
full House will begin debate on H.R. 3962 during the week of Nov.
2. Majority Leader Steny Hoyer (D-Md.) expects floor debate to begin
with consideration of a manager's amendment to H.R. 3962.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
AAMC Reiterates Health Reform Positions in Letter
to Senate Leaders
AAMC Chief Advocacy Officer Atul Grover, M.D., Ph.D., Oct. 27 sent
a letter to Senate leaders to reiterate AAMC positions on key provisions
in the health reform legislation (S.1796)
of greatest interest to the nation's medical schools and teaching
hospitals. The letter was sent to Senate Majority Leader Harry Reid
(D-Nev.), Senate Minority Leader Mitch McConnell (R- Ky.); Senate
Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member
Charles Grassley (R-Iowa); and Senate Health, Education, Labor,
and Pensions Committee Chair Tom Harkin (D-Iowa) and Ranking Member
Michael Enzi (R-Wyo.).
The AAMC recommendations include:
- Immediate and significant expansion of the physician workforce;
- Reform the problematic physician payment methodology and avert
the future cuts;
- Careful review and identification of the many drivers of variations
(e.g., income, race) in Medicare spending and resource use;
- Support for provisions reauthorizing the existing health professions
education and training programs under Title VII;
- The adoption of the Health Care Innovation Zones (HIZs) Pilot
Program (H.R.
3664) to health care reform legislation; and
- Belief that the Medicare Payment Advisory Commission (MedPAC)
already serves as an adequate independent advisory body to Congress.
The letters express the AAMC's "great appreciation for your
continued commitment to achieving comprehensive health care reform
that benefits all Americans." The AAMC pledges "continued
collaboration" and will work to "assure enactment of policies
that improve the health and security of our nation."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
AAMC and CAMC Brief Capitol Hill on Healthcare
Innovation Zones
The AAMC and the Congressional Academic Medicine Caucus (CAMC)
co-hosted an Oct. 27 briefing titled "Accelerating Healthcare
Delivery System Reform through Healthcare Innovation Zones."
The briefing, which focused on the transformative potential of Healthcare
Innovation Zones (HIZs) as part of
national health care reform, was the first event for the caucus
a new, bipartisan group of congressional members dedicated to maintaining
and strengthening the nation's medical schools and teaching hospitals
[see Washington
Highlights, Oct. 9]. AAMC President and CEO Darrell G. Kirch,
M.D., led the discussion, which also included Gordon Alexander,
M.D., president of the University of Minnesota Medical Center, and
Beth Felder, J.D., director of federal relations for Johns Hopkins
University School of Medicine.
The HIZ concept, introduced in Rep. Allyson Schwartz (D-Pa.)'s
Healthcare Innovation Zone Pilot Act of 2009 (H.R.
3664), would reduce costs and improve health outcomes by allowing
multiple providers and payers to partner and create health care
solutions tailored to their communities. "Most of what we as
a nation have been thinking about is how to insure more people,"
said Dr. Kirch. "When we talk about reforming health care delivery,
we sometimes seem to be hoping more than implementing. But we want
to motivate those on the front lines to use the tools of innovation
in a purposeful way. That's what healthcare innovation zones are
all about."
The briefing highlighted several academic medical centers that
are already testing new approaches to health care delivery. The
University of Minnesota Medical Center, part of Fairview Health
Services, is implementing 12 "care packages" that provide
central treatment locations for patients with various chronic conditions
and help reduce costs. "We need to fundamentally change payment
structures, and find new solutions for care," said Dr. Alexander.
"In the olden days, it was all about costs, but now, it's also
about innovation."
Additionally, the HIZ model would allow institutions and providers
to not only test and expand new care models, but also to track results
and measure outcomes. According to Ms. Felder, current Johns Hopkins
innovations have improved health outcomes and reduced costs for
approximately 160,000 Medicaid patients. "It would provide
academic medical centers around the country with an opportunity
to take what they know and design a system that works best for their
community," said Ms. Felder. "We can then study and evaluate
what we do and share that knowledge."
H.R. 3644 is not currently included in the pending House or Senate
health care reform proposals.
Information:
Len Marquez, Director
AAMC Government Relations
lmarquez@aamc.org
(202) 862-6281
Congress Approves Second Funding Extension
Congress Oct. 29 approved a second stop-gap funding measure to
keep the federal government running until Dec. 18. The funding extension
-- known as a continuing resolution (CR) -- is included in the House-Senate
conference agreement on the FY 2010 Interior-Environment appropriations
bill (H.R.
2996), which the House passed 247-178
and the Senate passed 72-28.
President Obama is expected to sign the measure before Oct. 31,
the expiration date for the initial CR that Congress passed as part
of the Legislative Branch spending bill (H.R.
2918) [see Washington
Highlights, Oct. 2].
Like its predecessor, the second CR funds most of the federal government
at FY 2009 levels for its duration but continues temporary increases
for the Veterans Health Administration and the Census that were
included in the initial funding extension.
The Interior-Environment bill would be the fifth of the 12 regular
FY 2010 appropriations bills that Congress has cleared for the president.
The House has passed all 12 bills while the Senate has approved
seven. Among the five bills awaiting Senate action is Labor-HHS-Education
(H.R.
3293).
Congressional strategy for dealing with the remaining bills most
likely will involve wrapping them into a small omnibus package,
which some on Capitol Hill are calling a "minibus." Democratic
leaders reportedly are considering using the Defense spending bill
(H.R.
3326) as the legislative vehicle to move the minibus, but any
of the remaining spending measures could be used for that purpose.
A further complication is the need for Congress to approve an increase
in the federal debt limit. The House automatically passed, without
a roll call vote, a $925 billion debt limit increase when it adopted
the FY 2010 budget resolution (S.Con.Res.
13). Senate Democratic leaders are said to be considering attaching
the debt limit increase to the Defense bill to avoid a straight
up-or-down vote on the debt. However, Senator Judd Gregg (N.H.),
the ranking Republican on the Budget Committee, has said he will
raise a point of order to strike the debt limit increase language
because it was not included in either the House or Senate passed
Defense bill. Democrats would need 60 votes to waive such a point
of order.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC, Higher Education Associations Renew Support
for Patent Reform Bill
A coalition of higher education associations that includes the AAMC has reiterated
support for the Patent Reform Act of 2009 (S.
515), which would be the first major reform of the patent system
in more than a half century. The associations' position was stated
in an Oct. 22 letter to Secretary of Commerce Gary Locke, in response to the secretary's
own correspondence expressing the administration's views on S. 515.
The Senate Judiciary Committee approved S. the bill for full Senate
consideration on April 2 [see Washington
Highlights,
April 3].
In expressing support for the legislation, the coalition -- including
the AAMC, the Association of American Universities (AAU), the American
Council on Education (ACE), the Association of Public and Land-grant
Universities (APLU), the Association of University Technology Managers
(AUTM), and the Council on Governmental Relations (COGR) -- noted
that the legislation balances concerns and interests across many
sectors, and also addresses concerns raised earlier by universities.
This balance is reflected in compromise provisions on the allocation
of damages from patent infringement. The bill also specifically
addresses university interests, such as by inclusion of a "grace
period" permitting inventors to publish their discoveries quickly
without invalidating subsequent patent applications (a provision
critically important to faculty scientists).
The associations expressed hope that, if the bill moves forward
in the Senate and in negotiation with the House, further modifications
might be made S. 515 relating to establishment of a mechanism by
which outside parties could challenge patent awards within the Patent
and Trademark Office. Specifically, the associations recommend language
that would make help prevent using post-grant opposition process
would to harass inventors with repetitive challenges. The coalition
of university associations also strongly opposed any further expansion
within the legislation of "prior user rights", which allow
industries to avoid penalties for infringement if they had previously
used a technology newly covered by someone else's patent. The associations
argue that the Constitution's intent for the patent system is to
promote disclosure society of inventions and discoveries, and not
to grant immunity to trade secrets, as would be conferred by expansion
of prior user rights.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Congress Postpones SBIR Reauthorization to January
The House Oct. 28 and Senate Oct. 29 voted to extend temporarily
through Jan. 31, 2010, the current authorization for the Small Business
Innovation Research (SBIR) program and other programs under the
Small Business Act and the Small Business Investment Act of 1958.
The extension (S.
1929) the third since the programs were scheduled to expire
July 31 allows lawmakers to continue working on legislation that
permanently reauthorizes the programs past Oct. 31 [see Washington
Highlights, Oct. 2].
Among other items, House- and Senate-passed reauthorization bills
differ on whether to increase the percentage of their budgets that
major federal research agencies, including the National Institutes
of Health, must devote to the SBIR program. The Senate-passed bill
(S.
1233) includes a provision to increase the allocation for the
SBIR program from 2.5 percent to 3.5 percent of any federal agency
budget that provides more than $100 million for research. AAMC opposes
increasing the allocation [see Washington
Highlights,
June 26]. The House bill (H.R.
2965) does not increase the set-aside.
The Senate Oct. 26 had approved a version of S. 1929 that extended
the current authorization through April 30, 2010. House lawmakers
shortened the extension before approving the bill and sending it
back to the Senate for a final vote.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
GAO Releases Report on the Medicare per Capita
Method for Profiling Physicians
The Government Accountability Office (GAO) Oct. 26 released a report titled "Medicare: Per Capita Method Can Be Used to Profile
Physicians and Provide Feedback on Resource Use." The report,
at the request of House Ways and Means Health Subcommittee Chair
Pete Stark (D-Calif.), examines the "use of per capita method
to profile physicians based on their patients' level of resource
use, and discusses the development and influence of feedback reports."
The report found that despite high patient turnover, specialist
physicians displayed considerable stability in resource use suggesting
per capita resource use is an acceptable method because "it
reflects distinct patterns of a physician's resource use" and
not the population seen by the physician. The report also found
with regard to the per capita method, "patients of high resource
use physicians used more institutional services than patients of
low resource use physicians."
The Centers for Medicare and Medicaid Services (CMS), agreeing
with the findings of the report, affirmed its "commitment to
developing meaningful, actionable, and fair measurement tools for
physician resource use that, along with quality measures, will provide
comprehensive assessment of performance."
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
HIT Policy Committee to Develop Strategic Plan;
Standards Committee Announces Blog
The Health Information Technology (HIT) Policy Committee Oct. 27
announced that it will begin to create the Federal Health Information
Technology Strategic Plan required by the American Recovery and
Reinvestment Act (ARRA, P.L.
111-5). The committee stated that its work on the strategic plan will be in addition to
its ongoing work on defining "meaningful use" criteria
for 2013 and 2015 and developing other HIT-related recommendations.
The committee intends to continue its work through the following
five workgroups: Meaningful Use; Adoption of HIT / Electronic Health
Records (EHRs); Privacy and Security; Nationwide Health Information
Network and Health Information Exchanges; and Strategic Planning.
During its Oct. 27 and 28 meeting, the committee also heard testimony
on the use of registries and quality measures, the unique concerns
of specialists, small providers, and providers meeting the needs
of the underserved in becoming "meaningful users" of EHRs.
Testimony addressed a wide variety of stakeholder perspectives on
"meaningful use" issues and included discussions about
how to define meaningful use criteria for specialists, how to define
and set goals for registries, and how best to encourage all providers
to take advantage of the ARRA HIT incentives.
The HIT Standards Committee's Implementation Workgroup Oct. 29
also heard testimony from stakeholders regarding "real world" standards implementation
experiences. The testimony focused on lessons learned about standards
implementation both inside and outside of the healthcare industry
and on challenges in collecting data and calculating performance
measures. Aneesh Chopra, chair of the workgroup, encouraged the
public to contribute to this discussion through the new Federal
Advisory Committee Act (FACA) blog.
The meeting agendas and all written testimony from the presentations
are available on the HIT Policy Committee and Standards Committee
Web sites. More detailed summaries of the meetings will be posted
to the AAMC HIT Web page.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
Senate Confirms Benjamin as U.S. Surgeon General
The Senate Oct. 29 approved by a voice vote Regina Benjamin, M.D.,
M.B.A., as U.S. Surgeon General. President Barack Obama announced
Dr. Benjamin as the Surgeon General nominee on July 13 [see Washington
Highlights, July 17].
In a July 14 statement,
AAMC President and CEO Darrell G. Kirch, M.D., praised Dr. Benjamin
as "a gifted physician with a strong commitment to caring for
the underserved and community health." Dr. Kirch noted that
"this nomination also appears to mark the first time that a
former participant in the National Health Service Corps (NHSC) could
serve as our chief public health official," observing that
the program is "critically important to America's future health
care needs."
Dr. Benjamin is founder and CEO of the Bayou Le Batre Rural Health
Clinic in Alabama, a primary care facility that treats all patients
regardless of their ability to pay. Her service within the medical
community includes her work as the Associate Dean for Rural Health
at the University of South Alabama College of Medicine and as Chair
of the Federation of State Medical Boards of the United States.
On the Agenda in Washington
Nov. 2-3: VA Research Advisory Committee on Gulf War Veterans'
Illnesses Meeting
8 a.m.; Room 230, Department of Veterans Affairs, 810 Vermont
Ave, N.W.
The Department of Veterans Affairs Advisory Committee on Gulf War
Veterans' Illnesses will meet to review VA program activities related to Gulf War Veterans' illnesses
and updates on relevant scientific research published since the
last committee meeting.
Nov. 2-3: Meeting of the CDC/HRSA Advisory Committee on HIV
and STD Prevention and Treatment
8 a.m.; Hyatt Regency Bethesda, 7400 Wisconsin Ave., (One Bethesda
Metro Center), Bethesda, Md.
The Center for Disease Control and Prevention (CDC)/Health Resources
and Services Administration (HRSA) Advisory Committee on HIV and
STD Prevention and Treatment will meet to discuss issues pertaining to HIV/STD/HCV prevention, treatment
and care in Federally Qualified Health Centers; biomedical approaches
to HIV prevention; and the role of surveillance in informing CDC
and HRSA activities.
Nov. 5: Senate Veterans Affairs Committee hearing on VA-Indian
Health Service Cooperation
10 a.m.; 418 Senate Russell Building
The full Senate Veterans Affairs Committee is scheduled to hold
a hearing on cooperation between the Department of Veterans Affairs (VA) and
the Indian Health Service (IHS).
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