Capitol Hill Report: Debate Moves to the States as Health Reform Waits Until September

August 3, 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 House and Senate Committees continue to work on wide ranging health reform bills. Just before recessing until September, the House Energy & Commerce (E&C) Committee wrapped up a bill that must be combined with measures passed by the House Ways & Means Committee, and a third passed by the Education & Labor Committee.

The Senate will be in session for another week in August, as the nomination of Judge Sonia Sotomayor is considered on the Senate floor. This gives lead negotiators in the Senate Finance Committee another week to draft what is the only chance left for a bipartisan health bill.

The key negotiators in this process are Senate Finance Chair Max Baucus (D-MT), Ranking Member Charles Grassley (R-IA), and committee members Kent Conrad (D-ND), Jeff Bingaman (D-NM), Olympia Snowe (R-ME), and Mike Enzi (R-WY).

House Democrats had been working to get a bill passed before the recess, but as mentioned in earlier posts, the House Blue Dog Coalition raised multiple objections on issues like the creation of a public insurance plan based on Medicare rates. In the middle of the week, E&C Chair Henry Waxman (D-CA) announced he had reached a deal with the moderate Blue Dogs. This immediately brought protests from more liberal members of the Democratic Caucus, 83 of whom belong to the Progressive Caucus. Many Progressive Caucus members have signed a pledge to oppose any bill that does not contain a "robust public plan." Although a bill eventually passed the E&C Committee, the issues between the Progressives and the Blue Dogs threaten to scuttle any agreement.

I talked with several members of Congress who were glad that a bill was not considered on the House floor for debate prior to the August recess. Rep. Dina Titus (D-NV), a freshman member representing the Las Vegas suburbs, told me that she really wants to get back to her district and hear what constituents have to say about the proposals on the table. Another freshman, Erik Paulsen (R-MN), shared that sentiment, saying that his residents in the Minneapolis suburbs are looking for more information; he hopes to have town meetings to discuss the issues.

I also had the opportunity to meet with Rep. Michael Burgess, MD (R-TX). Burgess is an OB/GYN from the Dallas area and a leading Republican on the E&C Committee. At the request of the Academy and other specialties, Burgess offered an amendment that would eliminate the Sustainable Growth Rate (SGR) and switch to the Medical Economic Index. This would be a more realistic reimbursement level and provide more secure access to physicians for Medicare beneficiaries. However, by the Congressional Budget Office's calculations, this would cost an estimated $330 billion. As we all know, this money will be spent every year in order to prevent doc cuts.

Unfortunately, owing to the amendment's $330 billion price tag, the Democrats defeated it 20-32, on a party-line vote. The House bill does eliminate the SGR, but does not ensure positive updates in the future.

What AAN Members Can Do

The health reform debate now moves to the states and districts. The Academy hopes that you will take time to engage your members of Congress on the issues that are important to neurology.

First, we must eliminate the SGR, which calls for physician payment cuts year-after-year.

Secondly, and more specific to neurology, members of Congress must understand that services are provided by a range of physicians, including neurologists. Awareness of this fact will create a better plan for incentivizing primary care by providing bonuses to the physicians who provide services. Send a message to your members of Congress on this important issue.

Lastly, if any of your members are holding town meetings, take the time to attend. They will really benefit from hearing from you!

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