Latest Developments in the Senate
After the Senate Finance Committee approved its version of health care reform, the Senate Leadership has been working on merging the Senate Finance Committee bill and the Senate Committee on Health, Education Labor and Pensions (HELP) legislation. While several major differences have been ironed out during the merging process, one of the outstanding issues is the inclusion of a public plan in the final legislation.
In order to ensure sufficient support for the health care reform legislation, Senate Majority Leader Harry Reid (D-NV) announced on October 26 that the Senate health care legislation will include a public plan with a clause that allows states to opt out. Senator Reid also announced that he hopes to finish merging the two bills and send the final version to the Congressional Budget Office for scoring. (CBO is required to develop a cost estimate for virtually every bill reported by Congressional committees to show how it would affect spending or revenues over the next five years or more.) The Senate is expected to start debating on their health care legislation by mid-November.
Latest Developments in the House
U.S. House of Representatives Speaker Nancy Pelosi (D-CA) recently announced that the House health care reform bill will include a public option. CBO has scored several versions of the public option:
- A “robust” option, paying physicians Medicare rates plus 5 percent, scores around $870 billion
- A “hybrid” option, which would expand Medicaid to 150 percent of poverty and would trigger Medicare-based rates if costs didn't go down, would cost $895 billion
- An option with negotiated rates also scores at $895 billion; this also expands Medicaid to 150 percent of the federal poverty level and lowers the actuarial value of the minimum plan that meets coverage requirements by two percentage points
House Leadership emphasized that they have not yet decided which public plan option that will be included in the House bill.
A coalition of House Democrats have apparently reached agreement with leadership to include several provisions that would require the Institute of Medicine (IOM) to study and make recommendations on reducing geographic disparities and promoting high value health care in Medicare payments. The study recommendations would be in place prior to implementation of a public option with an examination of geographic variations in health spending and recommendations for reducing those variations due within one year. The U.S. Department of Health and Human Services (HHS) would be responsible for implementing policies that reflect the IOM’s findings.
A second study would provide recommendations for changing the Medicare payment system to reward value care, defined as high-quality, evidence-based, patient-centered care. Congress could halt HHS’ implementation only through a joint resolution of disapproval (which requires a two-thirds majority in each chamber). The agreement also includes $8 billion for payment updates and 'hold harmless' adjustments during the first two years of implementation to ensure that lower-quality providers are not penalized.
In addition, Speaker Pelosi also announced that the merged House bill will begin closing the so-called 'donut hole' in coverage under Medicare Part D in 2010 by providing a 50 percent discount for brand name drugs purchased by affected recipients. The 'donut hole' is the difference of the initial coverage limit and the catastrophic coverage threshold, as described in the Medicare Part D prescription drug program of the United States. After a Medicare beneficiary surpasses the prescription drug coverage limit, the Medicare beneficiary is financially responsible for the entire cost of prescription drugs until the expense reaches the catastrophic coverage threshold.
The House is scheduled to begin debating the health care reform legislation on November 6, 2009, and the legislative language is expected to be released the week of October 26-30. Once it is made available, Heart Rhythm Society staff will be reviewing the legislative language and analyze its impact on EP practices.
