Capitol Hill Report: A Billion Here, A Billion There . . .

June 22, 2009


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299,

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.

US Senate Health Reform

There is no evidence that the late Senator Everett Dirksen ever said the quote attributed to him: "A billion here, a billion there, and pretty soon you're talking about real money," but the US Senate got a real wakeup call last week when the Senate Finance Committee's first health care reform bill was scored at costing $1.6 trillion over ten years.

The committee has delayed their markup of a reform bill until after the July 4 recess due to the costs, along with the fact that it only covers 16 million of the 47 million uninsured. Details of the bill have been very limited because it hasn't been released. On Thursday, a Washington Post blogger published a document entitled "Health Care Reform: Draft Proposal," which gives an overview but doesn't mention any physician proposals.

The Senate Health, Education, Labor, and Pensions Committee (HELP) is moving ahead without consulting the Finance Committee. HELP is of less importance to physicians because payment reforms are the jurisdiction of the Finance Committee. HELP began marking up a bill this week and have considered five of 388 offered amendments. At current pace it will take 37 days to go through the amendments. Also, the bill does not contain any information about a public plan or any of the costs. They are really working in the dark.

The Academy's proposal is to have Congress focus on patient needs rather than physician specialty designation. I am making available here the "leave behind" that has the support of several patient and provider groups. I have met with most of the Senate Finance Committee Democrats, but haven't gotten an agreement to propose our suggestion to focus on patients eligible for special needs plans. I talked extensively with a Republican staff member from the Finance Committee and was told that no one in the Senate is focusing on patients. If we can shift the discussion to focusing on high needs patients we could get things moving.

US House Health Reform

The House bill was released last Friday, but did not contain any cost or revenue data. The bill represents the plans of the chairs of the three committees of jurisdiction. The bill:

  • Wipes clean the accumulated deficits of the SGR
  • Provides an update for 2010 based on the Medicare economic index
  • Creates two new "SGR buckets"
    • One that allows volume of most services to grow at the rate of GDP plus 1%
    • A second bucket allows volume of primary care and preventive care to grow at GDP plus 2%
  • Provides a specific bonus for "primary care" physicians

I met with House Energy & Commerce and Ways & Means last week, where I talked with Energy & Commerce Health Subcommittee staff about our plan. They said that our special needs plans idea was strongly considered, but they also felt that it would be difficult for CMS to administer. Neurology would benefit from the 2% bucket that would contain many E&M codes, I was told, but the field would not benefit from the primary care bonus—and the primary care bonus language is straight from a MeDPAC recommendation.

We will be commenting on the House draft and working to engage other cognitive specialties to discuss the need to include specialties like neurology in any bonus programs.

Lastly, as I mentioned two weeks ago, I had the pleasure of spending a day on Capitol Hill with Tesha Monteith, MD, of Philadelphia. Dr. Monteith is a passionate advocate for headache research and we met with nine congressional offices to raise awareness of the struggles and cost of headache. We are pursuing an appropriation for the Congressionally Directed Medical Research Program in the Department of Defense to focus on headache research.

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