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 promised 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.
The approved House legislation (H.R. 3162) calls for a $50 billion increase in funding and would pay for it with both increases in the federal tobacco tax and cuts to subsidies given to Medicare Advantage plans. The bill contains provisions unrelated to SCHIP, including a halt to next year's planned 10% cut in the Medicare physician fee schedule; instead, a 0.5% increase would be put in place for 2008 and another for 2009.
The American College of Physicians praised both the House and the Senate bills but said that the college 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 American Academy of Pediatrics also praised the bills and called on Congress to create a compromise bill that includes at least $50 billion in new federal funding for SCHIP. “While the $35 billion included in the Senate bill is a good start, it's not enough to cover the eligible but unenrolled children in SCHIP or Medicaid,” AAP President Jay E. Berkelhamer said in a statement. AAP officials also praised provisions of the two bills that ease citizenship and identification documentation requirements and establish a pediatric quality measurement program.
Other medical professional societies called on Congress to craft a final piece of legislation that would include increased funding for SCHIP and the House provisions that halt Medicare cuts to physicians for the next 2 years.
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. Legislators are tired of physicians coming every year to Capitol Hill to talk about this issue.
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.
▸ 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 the formula 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, Mr. Trachtman said.
Dr. Edward Langston, board chair of the American Medical Association, said the House legislation is encouraging and shows a willingness to find alternatives to the SGR. But what the final formula will look like is still up in the air, he said.
But the American College of Cardiology expressed problems with the new structure for Medicare payments outlined in the House bill. The proposed payment structure would be based on a system of separate expenditure targets that ACC asserts would not take into account the appropriate growth in services, including many common cardiovascular services.
“While the ACC appreciates congressional efforts to stop Medicare physician payment cuts, it is critical that any new payment structure is fair to all physicians,” the ACC said in a statement. “The ACC urges Congress to resolve this issue before any final legislation is passed.”
The House bill also drew the ire of the insurance industry. America's Health Insurance Plans (AHIP) hailed the passage of the Senate legislation but is opposed to provisions in the House bill that would make cuts to the Medicare Advantage program. These 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, AHIP president and CEO, said in a statement.