Issued 11/20/09
Senate Majority Leader Reid Reveals Details of Senate Health Reform Bill
Late Wednesday afternoon, November 18, Senate Majority Leader Harry Reid (D-Nev) unveiled the long-awaited details of his proposed heath reform bill, which he titled “The Patient Protection and Affordable Care Act.” Reid’s legislation, numbering more than 2,000 pages in length, was largely crafted by combining legislative provisions contained in two differing health reform bills, one of which had been previously approved by the Senate Finance Committee and the other by the Senate HELP (Health, Education, Labor & Pensions) Committee. The process of combining the Senate Finance and HELP bills into one “merged” or amalgamated proposal has been underway behind closed doors for several weeks, as Reid has struggled, with help from the White House, to craft a combined proposal that would have a reasonable chance of successfully passing through the full Senate. Reid’s task has proved to be a difficult one, primarily because Democrats in the Senate have remained divided over reform issues and major legislative provisions that have been under consideration for inclusion in the amalgamated bill. Additionally, it remains a widely held view, that nearly all Republicans in the Senate will oppose passage of Reid’s bill as it is currently written. Controversial issues threatening unified support among Senate Democrats include: the legislation’s proposed cost; the extent to which mandates would be placed on individuals and employers; how the legislation would be paid for; the impact of the legislation on the federal budget deficit; and whether or not the proposal would include a public plan that some believe would unfairly compete with private health insurance plans. More recently, the extent to which the legislation might either further restrict or possibly expand access to abortions has surfaced as controversial issue that complicates advancement of the legislation.
As introduced, the Congressional Budget Office (CBO) estimates Reid’s legislation, when fully implemented, will cover 94% of Americans. CBO further estimates the ten-year net dollar cost of implementing the bill will be under $900 billion. Opponents of the legislation dispute these estimates and claim the legislation will ultimately cost much more. Reid’s bill includes several reforms intended to be implemented as early as 2010, including: elimination of lifetime and unreasonable annual limits on benefits; prohibiting rescissions of health insurance policies; extending dependent coverage up to age 26; ensuring consumer access to an effective appeals process; and others. A number of other reforms contained in the proposed legislation would not be implemented, either fully or partially, until 2014. Those reforms include: new rules to prohibit denying coverage or setting rates based on health status, medical condition, claims experience and other factors; the implementation of newly-created “exchanges” at the state level (that meet specified federal standards and requirements) intended to serve as marketplaces to obtain more affordable insurance coverage; the establishment of a government-run public insurance option available through the exchanges; and others.
Also included in the legislation is a major expansion of the federal Medicaid program and the creation of a variety of new federal programs intended to encourage wellness programs and disease prevention; Medicare payment reforms; and a variety of programs designed to ensure the adequacy of the nation’s workforce of health care professionals. At the time of publication of this bulletin, the ACA is continuing its detailed analysis of the proposed legislation and its advocacy for specific provisions expected to have significant impact on the chiropractic profession.
Reid Seeks Rare Saturday Vote on Procedural Motion to Begin Floor Debate
Now that Majority Leader Reid has released the details of his national reform proposal, the next step in the process of moving the legislation forward is an important procedural one known as a “motion to proceed” requiring 60 affirmative votes under the rules of the Senate. Successful adoption of this motion would allow Reid to bring his proposed legislation to the floor of the Senate, a step that would begin the formal process of debating and offering floor amendments to the legislation. At present, there are 60 Members of the Senate (including Democrats and Independents) that comprise the Senate Democrat Caucus. Accordingly, Reid must have the support of all 60 members of his caucus to successfully implement the “motion to proceed” because all Senate Republicans are expected to vote against the motion. If Reid fails to muster the 60 votes he needs in support of his motion to proceed, then a single member of the Senate in opposition to his bill can continue to block its consideration. At present, a vote on Reid’s motion is scheduled to occur during a rare Saturday session scheduled for November 21. Whether or not Reid will succeed in mustering the 60 votes he needs remains in doubt, as there are a small number of moderate-leaning Democrats that have major concerns with Reid’s proposal some of whom represent states with strong conservative or Republican leaning constituencies and are being heavily lobbied to block consideration of the legislation in its current form. Democrat Senators whose support is uncertain are thought to include Senator Blanche Lincoln (Arkansas), Senator Mary Landrieu (Louisiana), and Senator Ben Nelson (Nebraska). Assembling the 60 votes necessary for a successful vote on Saturday is further complicated by the fact that Senator Max Baucus (D-Mont), a safe vote in favor of the motion to proceed, is currently absent from Washington due to the deteriorating health status of a close family member. Whether Baucus will be able to return for the Saturday vote is not yet known.
While the Saturday timetable for moving forward remains uncertain, the ACA believes it likely that Reid will eventually muster the votes he needs to pass a motion to proceed and begin debating his bill in the Senate. Once that takes place, it is projected that the process of debating the bill and considering amendments to it will take at least three weeks – meaning that a final vote on the legislation in the Senate would likely not take place until late December. Additionally, to end the debate over the bill and shut off any continued “filibuster” of it, Reid will need to again muster 60 votes for a critical procedural step known as “invoking cloture.” Invoking cloture is a required step under Senate rules that must be imposed prior to scheduling a final vote on the measure. If Reid can obtain the 60 votes to invoke cloture, then the final bill would only require a simple majority vote of 51 to successfully pass out of the Senate. Obtaining the 60 votes he needs to successfully invoke cloture is viewed as a much more difficult task than obtaining the 60 votes needed to begin the debate process, because, for all practical purposes, a vote to invoke cloture will be seen as tantamount to a vote for the bill, as the critical cloture vote will set up the process by which a final vote will take place. With only 51 votes required for final passage, this is currently seen as a near certainty, if the cloture vote is successful.
Reid’s Reform Bill Includes ACA Supported Provider Non-Discrimination Provision
Of specific interest to the chiropractic profession, is the fact that Reid’s bill includes an important federal provider non-discrimination provision the inclusion of which was strongly advocated by the ACA. The provision, found in Section 2076 of the measure, would apply to ERISA and other health insurance plans, and is intended to serve as an important protection aimed at preventing insurance plans from discriminating against entire classes of non-MD health care providers, including DCs, based solely on their state license or certification. The inclusion of the provision in the Reid bill was primarily championed by Senator Tom Harkin (D-Iowa), current Chairman of the Senate HELP Committee and Senator Chris Dodd (D-Conn). The inclusion of the provision in Reid’s bill means the chiropractic profession will not have to launch what would likely be an uphill battle to insert the provision via the amendment process on the floor of the Senate. With respect to provision, ACA’s main mission now, is to work to ensure that the provision remains included in the final floor amended bill, assuming one is successfully voted out of the Senate. It is important to note that the recently House passed version of the heath reform bill (HR 3962) does not contain an identical provision, but does contain an important non-discrimination provision that seeks to maintain the applicability of state-enacted provider non-discrimination laws. The ACA will lobby for inclusion in any final bill to be enacted by Congress of both the House and Senate provider non-discrimination provisions.
Chiropractic Included in Other Provisions:
• Community Health Teams: Doctors of chiropractic are specifically included as potential members of interdisciplinary Community Health Teams. These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care. Community health teams are integrated teams of providers including specialists, other clinicians and licensed integrative health professionals as well as community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included in these patient-centered and holistic teams.
• National Health Care Workforce Commission: The bill establishes a National Health Care Workforce Commission to examine the current and projected needs in the health care workforce. The Commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and including them in the definition of health professionals. Schools of chiropractic are also included in the health professional training schools to be studied. The National Health Care Workforce Commission is tasked providing comprehensive, unbiased information to Congress and the Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs.
House Passes Bill to Stop Proposed 21.2 Percent Medicare Reimbursement Cuts for 2010– Senate Action Uncertain
Late Thursday, the House passed H.R. 3961, which will repeal the 21.2 percent Medicare fee reduction scheduled for January 2010. The legislation also alters the method for determining Medicare reimbursement rates and replaces it with what is being called a more “stable system.” This new system would put an end to the cycle that providers have been subject to over the past few years in which fee cuts are proposed but not implemented because of short-term patches offered by Congress.
Action in the Senate is unclear, however. Senators rejected a similar bill S 1776 in October, voting down a procedural motion, 47-53. Majority Leader Reid has promised to bring the physician payment bill back up after the Senate finishes work on health care reform. Look for updates on this legislation as the Senate considers this issue.
Support for CHIROVOICE and CHAMP Still Vital
A major tool that the ACA is using to help build support for chiropractic on Capitol Hill, is the national grassroots program called ChiroVoice. ChiroVoice is ACA’s ongoing effort to build, grow and maintain a national database of chiropractic patient e-mail addresses. When needed, the patients are “activated” via electronic bulletins issued by the ACA, and instructed to take specific action in support of pro-chiropractic legislation. The project, which is intended as a permanent, and continually growing resource is intended to benefit the profession and the patients its serves at by activating patients with respect to both federal and state-based issues. All DCs are urged join in support of this important program.
Become a Chiropractic CHAMPion
With health care reform activities accelerating in Congress, the American Chiropractic Association has launched the Chiropractic Health Advocacy and Mobilization Project (CHAMP), a one-year campaign to raise funds in support of strategic lobbying activities intended to boost chiropractic’s profile on Capitol Hill.
To donate online and to learn more on how you can help, visit www.ChiroCHAMP.org
Watch Health Reform Updates on Your Computer via YouTube
As always, keep up with the health reform debate via ACA and through video updates on the ACA members’ site on YouTube.
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