House passes temporary 3-month fix to Medicare MD Pay Cut -- Senate action needed

The House passed a defense bill tonight that includes 60 day halt to Medicare Physician 21.2% payment cuts scheduled to take effect Jan.1. The House included an amendment to the 2010 Defense Department appropriations bill, HR. 3326 that freezes Medicare payments at their current levels until Feb. 28, 2010.

The legislation now goes to the Senate, where Republicans are expected to filibuster it, forcing Senate Majority Leader Harry Reid (D-NV) to obtain 60 votes before the bill can be considered. This procedural hurdle will likely delay consideration of the bill until Friday or Saturday. This is a critical issue that has been inappropriately caught in the health care reform debate along with other critical issues impacting reimbursement such as excluding distribution prompt pay terms from Average Selling Price (ASP) calculations. We need health care providers to urge their Senators to act on these issues now with at least a temporary fix.

Good news for providers: Senate Expected to drop "Medicare-Buy In" Option

Reports starting Monday night are that top Senate Democrats are prepared to sacrifice proposals to expand Medicare in a bid to win over moderates and amass the 60 votes needed to pass their health legislation. While this will be portrayed in the media as "dropping the public option", this is actually very good news for health care providers that recognize the problematic issues that expanding Medicare to any 55 to 64 year olds would create at this time. Instead this leaves the Federal Employee Health Benefit Plan (and some expansion of Medicaid) as they resources to address the uninsured. We expect to see a CBO score on the revised plan today.

One urgent issue that remains unclear is whether Congress will fix the looming Medicaid physician reimbursement cut of over 20% that will go into effect in January 1st. In these economic times lets hope that Congress addresses this prospectively even if its just another temporary or one-year fix.

More votes on health reform amendments expected later this afternoon.

Specter-Brown file key amendment today to correct reimbursement issue impacting physician-administered drugs

This afternoon, Senators Specter (D-PA) and Brown (D-OH) filed an amendment to the Senate health reform bill that would exclude from the calculation of average sales price (ASP) prompt pay discounts extended to wholesalers up to 2% of wholesale acquisition cost (WAC) for a period of five years. This language is similar to language that was approved in the House Energy and Commerce Committee, but was not included in the final House bill.

This technical modification is essential to accurate and consistent reporting of ASP. This change would correct Medicare reimbursement to physicians and hospital outpatient centers to be consistent across products. This issue is critical to products that must be professionally administered including treatments for cancer, rheumatoid arthritis, and multiple sclerosis.

Physicians, hospitals and patient advocacy organizations should urge their Senators to ask Senator Reid to include the prompt pay amendment in the Senate health reform legislation.

With the potential growth of Medicare this issue takes on added urgency. The proposed language would also be consistent with similar language within Medicaid.

Next week looks to be busy for Senate on Health Reform

The second week of the Senate's official debate on its health care reform bill (S 3590) was marked by partisan floor speeches and resulted in adoption of only 7 of the nearly 300 filed amendments by press time. While the process has been slow, Senate Majority Leader Harry Reid (D-NV) reported earlier this week that a tentative agreement on a replacement for the public option has been reached.

Based on the limited details released to date, the agreement appears to establish private, nonprofit health insurance programs that would be set up by the Office of Personnel Management, much like the federal employees program. These programs would be run by private companies, but a new government insurance plan could be triggered if the private plans are not acceptable. The pending agreement would also allow uninsured people between the ages of 55 and 64 who lack insurance to buy into the Medicare program and expand the Children's Health Insurance Program. The agreement would also require health insurance companies to spend at least 90 percent of the premiums they collect on medical services. The compromise proposal is now at the Congressional Budget Office (CBO) for analysis and a score is expected by early next week.

Drawing ire from Republican senators, Senator Reid halted, temporarily, the contentious health care reform debate to focus on the year-end omnibus spending bill, HR 3288, adopted in the House yesterday. Reid shifted the upper chamber's priority to the spending bill while he awaits the CBO score on the alternative to the public plan option. Reid's decision to put the health care reform debate in a holding pattern pending CBO analysis, has delayed a controversial drug importation amendment to the health care legislation, along with a motion to limit its tax impact on individuals and married couples.

During a conference call last night with health care groups, Senate Majority Leader Harry Reid and Finance Chairman Max Baucus (D-MT) discussed the following time table as related to Senate health care reform bill:

• The Senate will return to health care on Monday, December 14 with the goal of completing consideration of all amendments by Tuesday, December 15 and begining consideration of procedural motions on Wednesday, December 16.
• The vote on final passage is targeted for Monday, December 21.

Despite the ongoing wrangling in the Senate over health care reform, the Senate is working to pass its reform bill as early as next week with the hope that the House will approve the Senate version before Congress adjourns for the year thereby limiting the need for a conference committee. Still other speculation suggests that the final bill may not pass the full Congress until Valentine's Day.

Senate Leaders Work on Compromise on Public Option as Debate Continues

The Senate Healthcare debate continues today and there is momentum toward compromise on some of the most polarizing issues. A potential compromise plan is being developed as an alternative to the public option that would allow the government to contract with private insurers, similar to the Federal Employees Health Benefits Program (FEHBP). This model was proposed by Obama during the election and is also similar to the approach used with success for Medicare Part D which had bipartisan support.

However, there are also reports that the compromise plan may also allow people over age 55 to buy-in to Medicare. This would probably generate significant concerns from health care providers including hospitals and physicians since Medicare reimbursement rates are often considered inadequate.

Today a team of Senate democratic freshmen proposed a range of cost containment proposals related to health care reform. Their proposal did not appear to have any controversial components but would expand or accelerate a wide range of cost containment strategies that have been discussed as part of health reform.

The Senate debate today will break at 12:30 pm EST and is expected to reconvene at 2:30 pm EST. We may see a vote on the abortion related amendment this afternoon. Also McCain has proposed an amendment that would grandfather all existing Medicare Advantage enrollees.

To date, the Senate has voted on 12 amendments of the 212 that have been offered to H.R. 3590.

Today the Senate Finally Began Votes on Amendments to Health Reform

Today, following three days of debates without a vote on a single amendment, the Senate has begun to vote on amendments to the health reform bill.

The first two votes were on two amendments related to women's health. The first, offered by Senator Barbara Mikulski (D-MD) would give the Health and Human Services secretary authority to authorize the services, with the aim of ensuring that women over 40 receive mammograms and other treatments. This amendment passed with a vote of 61-39, with Republican Senators Olympia Snowe, Susan Collins, and David Vitter voting for the amendment and Democratic Senators Ben Nelson and Russ Fiengold voting against it. An alternative amendment submitted by Republican Lisa Murkowski was defeated 41-59, with Sen. Ben Nelson voting with the Republicans.

McCain's motion to remove the Medicare cuts from the bill failed 42-58 but two democrats, Nelson and Webb, voted for it. Senior groups, including AARP, opposed the McCain amendment and argued that the cuts in Medicare were cuts to reduce waste and not cuts in benefits. Senator Michael Bennet's amendment requiring that nothing in the Patient Protection and Affordability Act will result in a reduction of guaranteed Medicare benefits passed 100-0.

With momentum finally building in the Senate debate it still remains unclear where we will end up on the public option and there were reports today that another proposal is expected to be revealed next week that would provide more of a compromise that the "opt-out" language currently in the Senate health reform bill. Thus far there is no variation of a public option that has attracted the support of 60 Senators.

Prediction of the day: Despite progress today, it remains difficult to imagine how the Senate will be able to pass health reform legislation before the the holidays. Possible but challenging especially given wild card issues such as abortion and the public option.