Capitol Hill Report: Obama Releases 2010 Budget

March 2, 2009

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By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299, mamery@aan.com

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

The Budget

President Obama outlined his 2010 budget Thursday morning. The document recognizes the impending crisis physicians are facing with a 21 percent cut in Medicare reimbursement looming on January 1, 2010, and 40 percent over the next seven years.

In the section titled "Reforming the Physician Payment System to Improve Quality and Efficiency," the Administration proposes $329.6 billion "to account for additional expected Medicare physician payments" over the next 10 years. The funds are described as the Administration's "best estimate of what the Congress has done in recent years," and, if adopted by Congress, would effectively eliminate the enormous deficit and scheduled Medicare physician payment cuts of 40 percent over the next seven years. While the full impact is not yet known, this large infusion of funds appears to meet the Academy's repeated call for a realistic budget baseline that assumes Congress will not allow the drastic cuts programmed under the current SGR formula to occur.

The document also signals the Administration's willingness to consider further modifications in the SGR formula, stating that "as part of health care reform, the Administration would support comprehensive, but fiscally responsible, reforms to the payment formula." It adds that "Medicare and the country need to move toward a system in which doctors face better incentives for high-quality care rather than simply more care."

The President's decision to propose a more realistic budget baseline for Medicare spending on physician services responds to a long-time advocacy goal of the Academy.

It is important to realize though, that the President's Budget is simply a starting point for discussion, as real health care reform will take place in the House and Senate committees with health care jurisdiction.

Hill Advocacy

I met with several members of Congress this week including freshman John Fleming, MD (R-LA). Rep. Fleming is family physician who expressed great interest in helping his fellow physicians and indicated that the crisis physicians are facing was one of his primary reasons for running for Congress. I also met with John Sullivan (R-OK), who as a member of the Energy & Commerce (E&C) Committee's Health Subcommittee could be a key player in health reform for the minority side. Congressman Bill Shuster (R-PA) was with Sullivan and learned a great deal about the plight of physicians from our conversation.

I also talked with Glenn Nye (D-VA). Nye is a freshman whose father is a cardiologist. He is well ahead of the field for new members on understanding health care issues and could be a player in the future, if he can hold on to his Republican leaning district in SE Virginia.

Lastly, I met with Nathan Deal (R-GA). Congressman Deal is the ranking member of the E&C Committee's Health Subcommittee. Deal understands the need for a physician fix and has been discussing the issue with his counterpart, E&C Health Subcommittee Chair Frank Pallone (D-NJ). Deal was particularly interested in physicians' perspective on workforce issues. He is concerned that if the federal government takes more control over health care through new programs such as government provided health insurance or government provided drug programs, that we will see a decrease in students entering the field as health care providers.

Headache on the Hill

Academy member Robert Shapiro, MD, PhD, of Vermont, hosted the second Headache on the Hill event this week. Thirty-six neurologists and headache advocates from around the country went to Congress to ask for more funding for headache within the budget of the National Institutes of Health. Academy staff also participated. Melissa Larson, Academy Program Manager for Advocacy Development, visited the congressional offices of Sen. Amy Klobuchar (D-MN) and Congresswoman Betty McCollum (D-MN). "It's very encouraging to see physicians and advocates who are so committed to a cause that they are willing to use their own resources to travel to Washington and voice their concerns to Congress," said Larson. Headache on the Hill participants visited 127 Congressional offices form 27 states in what was a very successful event.

Read all of Mike Amery's reports on the Capitol Hill Report page.