Bill passes in Senate; Next stop conference committee

24 December 2009 

This morning the U.S. Senate passed the amended version of its health care reform legislation, H.R. 3590, the "Patient Protection and Affordable Care Act" with a vote of 60 to39. Virginia senators Mark Warner and Jim Webb both voted in favor of the bill.

This bill, along with the previously passed House bill (H.R. 3962), will proceed to a conference committee where House and Senate negotiators will work to reconcile the differences between the bills.  Changes to the bill are certain as the House and Senate work on a compromise. Both chambers must pass the bill in identical form before it can be sent to the president for his signature and become law.   

Compared to the Senate bill as introduced, the amended version has several areas of improvement such as the elimination of the proposed tax on elective cosmetic surgery and elective medical procedures and the elimination of proposed enrollment fees for physicians who participate in Medicare and Medicaid.  The amended bill also excludes a public plan option and prevents reduction in specialty fees as a means to increase primary care and general surgery reimbursement.

Elements of the bill that are consistent with MSV policy include expanded access to health insurance coverage for the uninsured and underinsured, promotion of competition in health insurance through the development of health insurance exchanges, and insurance reforms including prevention of lifetime coverage limits, elimination of pre-existing condition requirements, and promotion of healthy lifestyles and preventive care.

Areas that are inconsistent with MSV policy and continue to raise concern include the lack of comprehensive medical liability reform, lack of physician anti-trust protection, and lack of scope of practice protection. In addition, the bill needs refinements to proposals related to the release of Medicare and quality improvement data, to the role and structure of the Independent Payment Advisory Board, formerly known as the Independent Medicare Advisory Board, and to the development of utilization rate assumptions for imaging services.

MSV weighed in with senators Jim Webb and Mark Warner via letter in July outlining the elements of health care reform that are consistent with MSV policies, as well as a number of areas of concern.  MSV has had on-going contact with our senators as the legislation has been considered.

The American Medical Association (AMA) supported the amended Senate bill with the caveat that changes are still needed when the House and Senate reconcile the differences in their bills in a conference committee.  The AMA has stated that, in addition to addressing these areas of concern, Congress must establish a “clear pathway for passage of a permanent repeal of the SGR formula early next year” in order for the AMA to support the final Conference Report. Please read the AMA’s Dec. 23 Health System Reform Bulletin which provides an overview of the changes to the bill the AMA was able to influence as well as a the letter the AMA has sent to Sen. Reid outlining its outstanding concerns. 

To view the voting record on H.R. 3590,  click here.

21 percent Medicare cut averted
Over the weekend, Congress passed a temporary extension of the 2009 Medicare Sustainable Growth Rate (SGR) conversion factor.  President Obama signed this legislation on Monday. The extension averts the 21.2% cut to physician payments scheduled to take effect Jan. 1, 2010.  At this time, consideration SGR repeal is apart from Congress' consideration of national health care reform. Senate leadership has pledged to consider a permanent repeal of the SGR formula after the holidays; the House has already passed legislation to repeal the SGR.  MSV continues to urge the Virginia congressional delegation to clear the way for a permanent SGR solution.