Health Reform Bill: What's Included

March 22, 2010

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On March 21, the US House passed the Senate Health Reform Bill "The Patient Protection and Affordable Care Act" (HR 3590) by a 219 to 212 vote. Thirty-four Democrats joined the Republican caucus to oppose the measure—see how your Representative voted. The bill now proceeds to President Obama, while a separate "corrections bill" (HR 4872) —also known as the "Reconciliation Act of 2010"—passed the House passed by a vote of 220 to 211. HR 4872 will go back to the Senate for final approval, where they are expected to pass the corrections bill with a simple majority.

Unfortunately, this legislation does not include a permanent repeal of the Medicare sustainable growth rate formula (SGR), nor does it include neurology in the primary care bonus section. The Academy did not take a position on this bill due to these missing elements.

What is Included In This Legislation

The following are initial highlights about what’s included in this legislation. A more in-depth summary of the 1,100 page bill will be posted online in the near future.

Cost: According to the Congressional Budget Office (CBO), the cost of this legislation amounts to $940 billion over 10 years.

Expanding Insurance Coverage: The CBO estimates an additional 32 million will be covered by health insurance by 2019.

Medicaid Expansion: According to the American Medical Association (AMA), the legislation provides 100 percent federal funding for the expansion of Medicaid coverage to all individuals under age 65 with incomes up to 133 percent of the Federal Poverty Level ($29,327 a year for a family of four) from 2014 to 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent thereafter.

Insurance Mandates: With a few exceptions, US residents will be required obtain health insurance by 2014. The exception includes those with low incomes. Individuals with income requiring them to pay taxes would face a fine of $325 or two percent of their income, whichever is higher, should they fail to obtain health insurance by 2015.

Pre-existing Medical Conditions: Beginning in 2014 insurers will be banned by denying people with pre-existing medical conditions.

Establishment of Independent Medicare Advisory Board: According to the Kaiser Family Foundation, this new board, comprised of 15 members, will submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. Beginning in April 2013, the Chief Actuary of CMS will be required to project whether Medicare per capita spending exceeds a specific threshold. If so, beginning in January 2014 the new board will submit recommendations to achieve reductions in Medicare spending.

Beginning January 2018, the target is modified such that the board submits recommendations if Medicare per capita spending exceeds GDP per capita plus one percent. The Board will submit proposals to the President and Congress for immediate consideration. The Board is prohibited from submitting proposals that would ration care, increase revenues or change benefits, eligibility or Medicare beneficiary cost sharing (including Parts A and B premiums), or would result in a change in the beneficiary premium percentage or low-income subsidies under Part D. Hospitals and hospices (through 2019) and clinical labs (for one year) will not be subject to cost reductions proposed by the Board. The Board must also submit recommendations every other year to slow the growth in national health expenditures while preserving quality of care by January 1, 2015.

Integration of Physician Quality Reporting Initiative (PQRI) and Electronic Health Records (EHR): Language in the bill extends the current PQRI and EHR reporting beyond 2010. The Secretary of Health and Human Services will be required to develop a plan no later than January 1, 2012.

Primary Care Incentives: Located in HR 4872, those who qualify as primary care service providers will receive a bonus of anywhere from five to 10 percent, which will be paid for from a Federal Supplementary Medical Insurance Trust Fund. Bill language defines primary care services as a health or nurse practitioner who:

  • Specializes in family medicine, general internal medicine, general pediatrics, geriatrics, or obstetrics and gynecology
  • Has allowed charges for primary care services that account for at least 50 percent of the physician's or practitioners total allowed charges

What the Academy is Doing

The Academy has and will continue to pursue an amendment (which has already been introduced by Sen. Amy Klobuchar  in the Senate and Rep. Betty McCollum in the House) that would add neurology to the list of specialties eligible for this incentive. Members in attendance at Neurology on the Hill on March 8–9, 2010 advocated for support of this amendment, which included asking their Congressional Representatives to ask the Congressional Budget Office to present a "score" (or cost) to Congress so they can begin to consider the issue. The Academy will also continue to work with other physician specialties to permanently repeal the flawed Medicare Sustainable Growth Rate formula, which is still scheduled to be cut 21.3 percent on April 1, 2010.

For more information on the reform legislation, the AMA has developed a FAQ document.

For questions contact Mike Amery, Academy Legislative Counsel, at mamery@aan.com.