AMA ADVOCACY UPDATE

July 31, 2009

House Energy and Commerce Committee mark up resumes

Yesterday, the House Committee on Energy and Commerce resumed its mark up of H.R. 3200, the American Affordable Health Choices Act of 2009, working late into the night considering amendments. Key amendments of particular interest to physicians were voted on during the debate on the following issues:

Comparative effectiveness:

An amendment offered by Rep. Michael Rogers (R-Mich.) was adopted to clarify that comparative effectiveness research could not be used by the federal government to deny or ration care. A second amendment was adopted, sponsored by Rep. Phil Gingrey, MD (R-Ga.), stating that the Centers for Medicare and Medicaid Services may not use federally-funded clinical comparative effectiveness research data to make Medicare coverage determinations on the basis of cost. A third amendment authored by Rep. Chris Murphy (D-Conn.) was adopted specifying that the work performed by the Center for Comparative Effectiveness must be based on consultation with, and review by, appropriate trade associations and professional membership societies.

Medicaid and Children’s Health Insurance Program (CHIP):

The Committee adopted an amendment offered by Rep. Murphy to ensure adequate Medicaid payment rates. Rep. Jerry McNerney (D-Calif.) and Rep. Murphy offered an amendment, which was adopted, specifying that coverage waiting periods under the CHIP program do not apply to children who lose health insurance coverage, who are under 2 years of age, or for whom health insurance coverage is unaffordable. An amendment offered by Reps. Joe Barton (R-Texas) and Nathan Deal (R-Ga.) to allow CHIP and Medicaid funds to be used to purchase private health insurance coverage was defeated.

Medical home:

Rep. Donna Christensen, MD (D-VI) successfully offered two amendments to provisions related to a community-based medical home pilot program requiring the Secretary to: (1) seek to eliminate racial, ethnic, gender, and geographic health disparities through the pilots; and (2) select one of the U.S. territories as a pilot location.

Medicare physician payment

: Rep. Michael Burgess, MD (R-Texas) offered an amendment, which was defeated, that would have replaced the sustainable growth rate (SGR) system with Medicare physician payment updates based on the Medicare Economic Index.

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Public health insurance option:

An amendment offered by Rep. Burgess, requiring provider payment rates under a public plan option to be negotiated and not based on rates paid by another public program, was defeated. This issue is expected to be considered again in an upcoming vote on the compromise agreement reached between committee chair Henry Waxman and members of the Blue Dog Coalition. A second amendment offered by Rep. Burgess to eliminate the public plan option was also defeated.

Medical liability:

Rep. Burgess offered an amendment that would have implemented federal medical liability tort reforms, including a $250,000 cap on noneconomic damages. This amendment was defeated. A second amendment, offered by Rep. Deal, that would have provided liability protections to physicians who transfer EMTALA patients to more appropriate health care facilities was also defeated. Rep. Bart Gordon (D-Texas) is expected to offer three additional medical liability amendments for the committee’s consideration today.

The committee is scheduled to resume its mark up of H.R. 3200 at 10:00 ET this morning. Please go to

www.energycommerce.house.gov to track amendments and votes throughout this process.

Senate Finance Committee mark up postponed until fall. Physicians groups need to work Senate offices on Medicare physician payment issue

Bipartisan negotiations between members of the Senate Finance Committee are ongoing, and committee chair Max Baucus (D-Mont.) announced yesterday that the panel would be unable to mark up a bill before Congress returns from its summer recess in September. He pledged that negotiators will continue to meet during the month of August to resolve their differences.

Details of agreements that have been reached thus far began to emerge this week, although no information is available in writing. It has been reported that negotiators have scaled back the Medicare physician payment relief in the compromise package to a one-year temporary halt to the payment cuts being produced by the SGR formula. Currently, the committee proposal would provide a 0.5 percent Medicare physician payment update in 2010, in lieu of a scheduled 21.5% cut. The AMA and its coalition partners will be working over the August recess on strategies to secure a repeal of the irrational Medicare physician payment formula this year. This includes laying the ground work for a Senate floor amendment to replace the SGR. As previously reported, the House health reform package (H.R. 3200) would erase the SGR debt and establish a new Medicare physician payment formula. The Obama Administration has taken a number of steps this year to facilitate efforts to replace the SGR with a new payment formula. During August, physician groups will need to educate Senators on the need to scrap the SGR instead of creating another temporary "patch."