Capitol Hill Report: No Health Reform Votes Before Fall

July 27, 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.

Health Reform is grinding to a halt in both the House and Senate as Congress approaches its scheduled August recess. As of this writing, H.R. 3200—"America's Affordable Health Choices Act of 2009"—remains in limbo. Although the bill has passed two congressional committees, the House Energy & Commerce Committee has cancelled scheduled mark-ups of the bill and it is unclear if or when it will proceed. This situation is due to the current opposition of seven Democrats, members of the Blue Dog Coalition, as well as that of all Republicans on the panel. House leadership is negotiating with the Blue Dogs, who are concerned about the cost of the plan and the creation of a public plan insurance option.

Meanwhile, Senate Democratic leaders have abandoned plans for a vote on health care before the recess. Senate Majority Leader Harry Reid (D-NV) delivered the official pronouncement on Thursday, saying, "It's better to have a product based on quality and thoughtfulness rather than try to jam something through." Senate negotiators—including Finance Committee Chair Sen. Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA)—continue to work through a draft, but have been unable to come to an agreement to move a bill into the full committee. I discussed the progress with Finance Committee member Sen. Mike Enzi (R-WY), who is also ranking member on the Health, Education, Labor, and Pensions Committee (HELP). Enzi is participating in daily conferences with Senators Baucus, Grassley, and others. He said the group has identified 13 areas that need to be worked through and that they have touched on just three in the last two weeks, making progress very slow.

Rod Larson, the Academy's Chief Health Policy Officer, joined me on Capitol Hill last Wednesday. As I mentioned two weeks ago, we are trying to ensure that neurology is included in the list of physicians eligible for bonuses for providing evaluation and management (E/M) services. We are hopeful that we will be included in the Senate bill when the first draft is released, although we are not currently in the House bill. Larson came to DC specifically to meet with Earl Pomeroy (D-ND), a Blue Dog Democrat who sits on the Ways & Means Committee. Larson and Congressman Pomeroy have known each other for many years, going back to when they both served in the North Dakota legislature. Pomeroy was frank with us: He was one of three Democrats who opposed H.R. 3200 on final passage in the Ways & Means Committee. Because of that, any changes Congressman Pomeroy asks for are immediately met with the question from fellow Democrats of whether it will change his vote. For that reason, asking him to be the sponsor of any amendment is not a good idea.

We did have some success with the staff of Sen. Amy Klobuchar (D-MN), who represents the region in St. Paul, MN, where the Academy's main office is located. Klobuchar's staff agreed to take the lead on considering the Academy's proposal to reform the physician payment system. The reforms would put the focus on patients by paying bonuses to physicians who coordinate the care of Medicare beneficiaries eligible for Special Needs Plans. The bonus would apply only to evaluation and management services, and would lead to a more level playing field for physicians who provide cognitive care. (Read more about this issue in my July 6 post, "Health Care Reform - Focusing on the Patient.")

Lastly, Larson and I met with the staff of the Senate's most junior member, Al Franken (D-MN). He has hired a legislative assistant for health fresh from the Senate's HELP Committee, where Franken is a member. This is good news because it will help him get up to speed on issues before the HELP Committee, including many that are important to the Academy. As the only major national specialty society based in Minnesota, we expect to develop a good relationship with Sen. Franken, just as we have with several other Minnesota members.

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