As Congress returns from its August recess, the fate of reauthorization of the State Children's Health Insurance Program as well as physician pay relief are both up in the air.
In a month's short time, a House/Senate conference committee must reconcile the vastly different bills passed by each house, and craft the legislation into something that might escape a threatened presidential veto.
Before breaking for its August recess, the Senate overwhelmingly passed S. 1893, which includes a $35 billion increase for SCHIP. The funds would come from an increase in the federal tobacco tax.
However, the approved House legislation (H.R. 3162) contains a number of provisions unrelated to SCHIP. For example, the bill would halt next year's planned 10% cut in the Medicare physician fee schedule, instead putting in a place a 0.5% increase for 2008 and another for 2009.
In terms of SCHIP funding, the House bill calls for a $50 billion increase in funding and would pay for it with an increase in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans.
Officials at the American Academy of Family Physicians favor a final bill that includes SCHIP funding that would cover as many children as possible, 2 years of positive updates to the Medicare physician fee schedule, and a commitment to fixing the sustainable growth rate formula, said Dr. Rick Kellerman, AAFP president.
Two years of positive updates are important, Dr. Kellerman said, because legislators are tired of physicians coming every year to Capitol Hill to talk about this issue.
“We think we've got a lot of other important health care issues to deal with,” Dr. Kellerman said, adding that a 2-year fix will give Congress time to evaluate the sustainable growth rate (SGR) issue and formulate an alternative. “It's a transitional bill. This gets us through the next 2 years.”
The American College of Physicians praised both bills but said they would like to see final legislation that includes some of the Medicare provisions passed by the House, including the temporary pay fix for physicians.
The House bill also outlines a new physician payment structure under Medicare that would set a separate conversion factor for six service categories: evaluation and management for primary care, evaluation and management for other services, imaging, major procedures, anesthesia services, and minor procedures.
The proposed formula would also take prescription drugs out of the spending targets and would take into account Medicare coverage decisions when setting targets, according to Rich Trachtman, American College of Physicians legislative affairs director. But it would still lead to deep payment cuts starting in 2010, so there is an understanding among legislators and leaders in medicine that the updates for 2010 and beyond would require additional action, he said.
The American Academy of Pediatrics praised the passage of the two pieces of legislation as well as the provisions in both that would ease citizenship and identification documentation requirements.
However, although the America's Health Insurance Plans (AHIP) hailed the passage of the Senate legislation, it is opposed to provisions in the House bill that would make cuts to the Medicare Advantage program. The cuts could result in more than 3 million seniors losing Medicare Advantage coverage and having to switch to fee-for-service Medicare, where they would likely pay higher out-of-pocket costs, according to the AHIP.
“The House bill shreds the safety net for millions of seniors who depend on Medicare Advantage,” Karen Ignagni, the president and CEO of AHIP, said in a statement.
The House bill also includes some protections for Medicare beneficiaries. For example, it would codify protection for six drug classes under Medicare Part D. Starting in 2009, Medicare drug plans would be required to include all or substantially all Part D drugs in each of the following classes: anticonvulsants, antineoplastics, antiretrovirals, antidepressants, antipsychotics, and immunosuppressants.
The bill would also waive cost sharing for Medicare beneficiaries for certain preventive services including diabetes outpatient self-management training services, cardiovascular screening blood tests, diabetes screening tests, screening mammography, screening Pap smear and pelvic exam, and bone mass measurement.