Capitol Hill Report: Massachusetts Senate Race Complicates Health Reform

January 20, 2010

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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.

Health reform negotiations were nearing the end between the House and Senate, but voters in Massachusetts shook things up on Tuesday by electing Republican Scott Brown to fill the seat held by Ted Kennedy (D-MA), who passed away last fall. As part of his campaign, Brown promised to be the forty-first Republican vote to deny Democrats a 60-vote, filibuster-proof majority on health reform. The big questions in Washington today are: "when will Brown be allowed to take his seat?" and "will Democrats be able (or willing) to complete health reform before he is seated?" Majority Leader Harry Reid (D-NV) said yesterday that Brown would be seated when the Senate receives "the proper paperwork." This could take several weeks, since Massachusetts won't submit an election certificate for at least ten days while honoring the federal law requiring receipt of absentee and military votes. This, even though the Democratic opponent Martha Coakley has conceded. In another complication, Massachusetts precedent seems to call for seating Brown earlier than the law allows: Sen. Kennedy was seated just two days after his special election victory in 1962, and current US Rep. Niki Tsongas (D-MA) was seated just days after her special election victory for the House in 2007.

Neurology Amendment

As negotiations come to an end (although health reform may not move at all) the neurology amendment is still in play as Congresswoman Betty McCollum (D-MN) and Ed Perlmutter (D-CO) sent a letter to House Speaker Nancy Pelosi (D-CA) asking her to request the Congressional Budget Office (CBO) to score our amendment. That means that the CBO will come up with a cost estimate of the provision. Sen. Amy Klobuchar (D-MN) has previously requested the same from Senate leadership. We will not be able to move forward with the amendment until the CBO has an official score.

Physician Payment Fix

The health bill does not include a permanent fix of the Medicare physician payment problem known as the "sustainable growth rate" or SGR. The House has passed a stand-alone bill, HR 3961, which provides a permanent fix, but earlier, the Senate rejected a similar measure. At a meeting of hosted by the American Medical Association (AMA) last week, specialty groups were told that House and Senate leadership have indicated that a permanent fix is on the table and will be added to legislation after health care reform.

A number of groups are upset with the AMA for their support of health care reform and AMA representatives were asked about potentially losing leverage over the SGR issue if health care reform passes before a permanent physician fix. If a permanent SGR fix is not included, it will represent many years and millions of dollars of waste by the physician community in pursuing this issue. The House of Medicine is going to have to determine if it continues to pursue this issue or tells its membership that Congress is unable to make the difficult decisions that will guarantee access to care for Medicare beneficiaries. Specialties also talked about all of the health care policy decisions that Congress makes by impacting the Medicare program such as the Physician Quality Reporting Initiative (PQRI) and if physicians do not like all 110,000 pages of Medicare regulations, there is a way to not be subject to those regulations.

Congressman Burgess (R-TX)

I attended an event with several other physician specialty groups this week for Congressman Michael Burgess (R-TX). Dr. Burgess is an OB/GYN from North Texas and is the only Republican who supported HR 3961, which provides a permanent SGR fix. He said four or five other Republican physicians had considered supporting it together and were going to discuss it among each other if any of them were wavering. "Of course," he said, "that didn't happen as we cast our votes." That left Burgess as somewhat of a hero to the physician community for being the only one to stand against his caucus on such an important vote. It should be noted that Republicans also support a permanent repeal of SGR, but objected to HR 3961 because CBO has estimated its cost to be $210 billion over 10 years.