Endocrine Insider
July 22, 2009
(See Full Issue)

House Democratic leaders from the Energy and Commerce, Labor and Education, and Ways and Means Committees introduced comprehensive health care reform legislation on July 14 designed to expand access to affordable health care and improve quality. “America’s Affordable Health Choices Act” (H.R. 3200) includes a public plan option and a health insurance exchange to facilitate the comparison and purchase of health insurance. The legislation also reforms the insurance market by requiring guaranteed coverage and creates an advisory body to develop a basic benefits package that eventually will become the minimum package for employer-sponsored plans.

In response to the draft legislation released by the three House committees, The Endocrine Society provided comments on provisions in the bill that would impact endocrinologists, such as providing for a greater rate of growth for evaluation & management services under a new sustainable growth rate formula and providing a bonus to physicians that participate in both the public plan and Medicare.  Analysis of the bill shows that there are a number of provisions that may actually benefit the specialty.  However, it is likely that the bill that reaches the House floor will be significantly different than the bill that was introduced on July 14. 

The Energy and Commerce Committee began marking up H.R. 3200 on July 15 and is expected to continue its work through this week. Following a 16-hour markup, the Ways and Means Committee approved its part of the health reform legislation on July 17, though all of the committee’s Republicans and three Democrats voted against the bill. The Education and Labor Committee also approved its portions of the bill on July 17.  Once the legislation is approved by the Energy and Commerce Committee, the different committees’ versions of the bill will be merged by the House Rules Committee and sent to the House floor for a vote, likely before the August recess.

Meanwhile, in the Senate, the Finance Committee and Health, Education, Labor and Pensions (HELP) Committee have been working on separate language that will eventually be merged into one health reform bill.  The HELP Committee passed the “Affordable Health Choices Act” on July 15, a bill that includes an employer mandate and a public plan option. The legislation prohibits insurance companies from denying health coverage due to pre-existing conditions and also eliminates annual or lifetime limits on coverage. The committee voted along party lines, 13-10.

In testimony before the Senate Budget Committee on July 16, Congressional Budget Office (CBO) Director Douglas Elmendorf said health reform legislation drafted by Congressional Democrats would increase federal spending.  The CBO released a 10-year cost estimate of the House reform bill which indicates the Democratic bill would add $239 billion to the federal deficit. The estimate includes the cost associated with overhauling the current Medicare physician payment formula, which CBO believes will be $245 billion. Lawmakers on both sides of the aisle have indicated Congress is likely to set aside Congressional budget rules and not offset that cost with budget cuts or tax hikes because of its magnitude.

The House legislation has received widespread support from the medical community, with support being offered for the entire bill or specific provisions by the American Medical Association and several primary care and medical subspecialty societies.  However, some surgical subspecialty societies and eight state medical societies have announced their opposition to the legislation, citing concerns over the public health insurance option, an unaddressed shortage of surgeons, the proposed curtailing of physician-owned specialty hospitals, and comparative effectiveness research, among others.  The Society will continue to analyze future iterations of the legislation and provide updates to the membership.