Capitol Hill Report: Tired of Tough Votes

April 27, 2010


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299,

This edition of Capitol Hill Report goes into specific details about the politics that kept neurology out of the health care bill, as well as the Academy's plans for moving forward.

Congress Averts Medicare Cut…For Now

I hope I got a chance to talk with you if you stopped by the BrainPAC booth or attended one of the many sessions we had on health care policy and politics at the Academy's Annual Meeting in Toronto. It is always one of the highlights of my year to be able to discuss the politics of health care with Academy members.

A quick update on the Sustainable Growth Rate (SGR) physician reimbursement fix: Congress approved and President Obama signed legislation that temporarily delays a scheduled 21-percent cut to Medicare physician payments. The Senate approved the legislation in a 59-38 vote, with the support of Republican Sens. Susan Collins and Olympia Snowe of Maine and George Voinovich of Ohio. The House immediately took up the measure and passed it 289-112; 49 Republicans voted for the legislation.

The cuts are now scheduled for June 1, 2010, unless Congress acts again. This is the seventh time in seven years that Congress has voted not to impose cuts by pushing the problem down the road for another day. The Academy continues to call on Congress to repeal the formula. According to the Congressional Budget Office (CBO), the cost to permanently fix the problem is more than $200 billion over 10 years. I was discussing this issue with Sen. Ron Wyden (D-OR) last week and asked if he thought the cut would ever really go into effect. He said the day that happens is the day that physicians everywhere put up signs on their doors that say "go get your health care from your member of Congress." That being said, the problem still persists.

The Misnamed Primary Care Incentive

The talk around the Annual Meeting was about the loss of consult codes and, of course, the neurology amendment. As you know, Academy members and staff have been working vigorously on both of these issues for several months. The AAN is participating in an AMA-sponsored survey to get the impact of the loss of consult codes. I hope you take the time to participate in the survey before it closes on Friday, April 30.

I talked last week with Congressman Ed Perlmutter (D-CO) who agreed to send a letter to MedPAC asking whether neurology should be included in the 10-percent bonus for primary care physicians. I discussed with him—as I discussed with many of you at the Annual Meeting—that the "primary care incentive" is misnamed. It really should be the "evaluation and management care incentive." We already have started a campaign on Capitol Hill to make members aware that neurology needs to be included in any technical corrections legislation that moves in 2010. We are uncertain that any will move forward in 2010, but if it does we will be ready with the help of members like Congressman Perlmutter and Betty McCollum (D-MN). Other members are taking interest as well. I received a call from the staff of Congressman Patrick McHenry (R-NC), who said that the Congressman has been hearing from constituents on the issue. His staff asked that we contact their office right away if our issue starts to move and needs support.

Tired of Tough Votes

The reason that action might not happen in 2010 is that Congress is tired of taking tough votes. There have been a number of these in the 111th Congress. Cap and trade, health care, and bailouts have left Americans discontented about members of Congress, both Democrats and Republicans. Congressional approval rates are at all-time lows. With anti-incumbent sentiments outside Washington, those running for reelection are running scared, but will it actually result in losses for incumbents? Sen. Wyden said his reelection prospects are looking good. His Oregon constituents say that they can't stand Congress, but say to him, "I guess you're ok." Congressman Henry Cuellar (D-TX), who I met with last week, is a strong supporter of adding neurology to the incentive. He told a group of us that his prospects for re-election were also very good. He didn't mention the name of his opponent other than to say that the challenger in his south Texas district is a three-time convicted felon. There are many on Capitol Hill who could only wish for such luck as the November elections approach.