Endocrine Insider
August 6, 2009
(See Full Issue)

As Congress begins the August recess, many questions remain on health reform proposals.  Prior to adjourning, the House Energy and Commerce Committee (E&C) completed its mark-up of the legislation drafted by E&C leadership in cooperation with the leadership of the Education and Labor Committee and the Ways and Means Committee (H.R. 3200).  The other committees had previously approved their own marked-up versions of the bill.  In order to gain support from enough committee members to ensure passage, E&C Committee Chair Henry Waxman (D-CA) came to an agreement with the Blue Dogs, fiscally conservative Democratic members of the House, on a number of amendments.  Part of the agreement with several Blue Dog Democrats was a commitment from House leaders to refrain from bringing the bill to the floor for a vote until after Congress returns from the August recess in order to provide lawmakers sufficient time to review the language. The compromise, which would reduce the overall cost of the bill by $100 billion, states that health care provider participation in the public option plan would be voluntary, that provider payment rates would be negotiated and not based on Medicare rates, and that safeguards would be established to ensure a level playing field for private plans. While some additional amendments will be added to H.R. 3200 in September through a separate bill, House leaders will now begin the work of melding the bills approved by the three committees for consideration by the full House this fall.

Also in an effort to gain support from the Blue Dogs, President Obama offered his own proposal to create an Independent Medicare Advisory Council (IMAC) with the authority to make changes to the Medicare program that, unless overridden by Congress within 30 days of introduction, would be implemented. In a July 25 letter to House Majority Leader Steny Hoyer (D-MD), Congressional Budget Office (CBO) Director Douglas Elmendorf wrote that enacting the Administration’s proposal would yield modest savings of $2 billion over the 10-year period. However, all of the savings would be realized in the final four fiscal years 2016 through 2019. The White House’s plan has faced significant pushback from many industry stakeholders who disagree with the idea of having unelected independent officials, appointed by the President, setting Medicare policy. As a result of the modest savings and the concerns raised by stakeholders, many experts believe the plan will ultimately be excluded from health reform legislation.

Two Senate committees are also grappling with health reform proposals.  Although the Senate Health, Education, Labor and Pensions Committee passed its version of a health reform package, the Senate Finance Committee has yet to approve a bill.  Senator Max Baucus (D-MT), chair of the Finance Committee, is intent on producing a bill for consideration by the committee that has bipartisan support.  To achieve this, Baucus and a bipartisan group of five other Finance Committee Senators have continued daily meetings over the past several weeks in order to craft an agreement. According to members of this group, the key sticking points in negotiations center on paying for the overall cost of the reform bill, ensuring that health insurance is affordable, and addressing the concerns of state governors regarding the additional costs associated with expanding Medicaid eligibility. According to a CBO analysis, the draft legislation produced to date by the Finance Committee would cost less than $900 billion and would cover 95 percent of Americans.