Capitol Hill Report: Meeting the Majority Leader

February 2, 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.

Last week I met with Senate Majority Leader Harry Reid (D-NV), who said that Democrats have no timeline for health care and are stepping back to review all of the options after the election of Scott Brown (R-MA) to the Senate. He did make it clear that he was very disappointed in Republicans and what he called their "obstructionist policies" to stop all legislation for moving through the Senate. Reid walked through a scenario of trying to get a bill from being introduced on the Senate floor, going all the way through to final passage. He showed that it takes almost two weeks if Republicans use all the procedural delays available to them.

I asked Reid about physician reimbursement and permanent elimination of the sustainable growth rate (SGR). Reid said that a deal was being worked to provide for a five-year fix to the physician reimbursement issue. He would not commit to a permanent repeal, although he and every other member of Congress would certainly like to see one.

That said, last Thursday the Senate passed H.J. Res 45, which is a resolution to raise the federal debt limit. H.J. Res 45 reinstitutes "PAYGO rules" for new spending, meaning that any new spending or tax cuts would have to be offset by corresponding spending cuts or tax increases. However, several limited exemptions were made, including one affecting SGR for five years. This means that up to $82 billion in spending for an SGR fix would not be required to be offset by other revenue or cuts. This exemption does not implement new Medicare physician payment policy, so there is still work to do in preventing a 21 percent cut in physician reimbursement now scheduled for March 1, 2010. The House is expected to take up H.J. Res 45 this week.

Sen. Reid is in for a tough election campaign in Nevada; with the Massachusetts election, he has lost his sixtieth vote in the U.S. Senate; and Republicans are letting very little in the way of legislation through the Senate. Although I did not have the opportunity to bring up the Academy's efforts to include neurology in the list of specialties eligible for a payment bonus for cognitive care providers in the health bill, I was able to talk about the issue with his top health policy staff member following the meeting.

House Plans

House Democrats convened a meeting last week, during which most members agreed that shelving health care reform is not an option. Currently, Democratic leaders and members from both chambers disagree on whether to develop a series of scaled-back bills to draw Republican support, force the House to pass the Senate's bill as it currently stands, or adopt a parliamentary procedure that would allow Senate Democrats to pass the bill with a simple majority of votes.

Neurology Amendment

The slow down on health reform helps the Academy's efforts to include neurology in the health bill. I talked with Congressman Henry Cuellar (D-TX) who has been a supporter of our efforts. We are working with his staff to make a congressional inquiry with the Congressional Budget Office (CBO) on where they are in the process of scoring the provision. Not having an official cost analysis from the CBO continues to hamper our efforts, so the fact that health care reform is in a lull at the moment actually helps our cause. It appears more likely that health reform will still be in play in early March, when more that 100 Academy members come to Washington for Neurology on the Hill. This will surely be a top issue for advocates to take into their congressional offices.