The U.S. House of Representatives has passed health reform legislation, clearing the way for approximately 32 million previously uninsured Americans to access health insurance in the next few years.
Late in the evening on March 21, the House voted 219-212 to approve the health reform bill passed by the Senate last December. The bill (H.R. 3590) creates a health insurance exchange where individuals can shop for insurance that meets minimum coverage standards. It also requires individuals to obtain health coverage and bars insurers from discriminating against people based on gender or preexisting medical conditions. President Obama was expected to sign the bill into law as early as March 23.
Later the same night, the House voted 220-211 to approve a package of changes to the original Senate-passed bill. This legislative package would cover 32 million additional Americans, or about 94% of the population, according to the Congressional Budget Office (CBO). The CBO estimated the cost of the legislation at $940 billion over 10 years and said it would reduce the deficit by $143 billion from 2010 to 2019.
The second piece of legislation, known as the reconciliation bill (H.R. 4872), removes some of the controversial elements of the Senate-passed bill. For example, it stripped out the so-called "Cornhusker kickback," a provision that would have required the federal government to pick up the cost of expanding Medicaid coverage in Nebraska.
The reconciliation bill, which now moves to the Senate for a vote, includes increased federal subsidies for Americans who can't afford to purchase health insurance and also lowers financial penalties for individuals who choose not to purchase insurance.
Of interest to physicians, the reconciliation bill increases Medicaid payments to primary care physicians. The bill requires that Medicaid payments be increased up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014. It also increases funding for community health centers.
The bill also provides aid to Medicare beneficiaries who fall into the Medicare part D prescription drug "doughnut hole." This year, beneficiaries who enter the doughnut hole will get a $250 rebate. Next year, drug companies will be required to provide a 50% discount on brand-name drugs in the doughnut hole, rising to 75% on both brand-name and generic drugs by 2020.
The reconciliation bill also beefs up the insurance reform provisions of the Senate-passed bill. Under this new bill, the federal government would require health plans to provide coverage for nondependent children up to age 26 years within 6 months. It also bars group health plans from excluding people on the basis of pre-existing conditions starting in 2014. For children, plans would be barred from pre-existing conditions exclusions 6 months after enactment.
Although Democrats in the House were able to get the needed votes to pass the two measures, neither received a single Republican vote. In the hours of debate that preceded the bill, Republicans railed against the package as bloated and unaffordable, despite assurance from the CBO that the legislation would reduce the deficit. They also said that the legislation called for too great a role for the federal government and would interfere with the relationship between patients and their doctors.
But the bills were backed by the American Medical Association. On March 19, the organization announced its "qualified" support for the amended version of health reform. AMA President Dr. J. James Rohack said that the bill would do many good things, such as improve health by expanding coverage to millions of uninsured Americans, eliminate denials based on pre-existing conditions, provide bonus payments to primary care physicians and general surgeons, and fund pilot projects on ways to resolve medical liability claims.
Congress, however, still has work to do on provisions such as the one establishing the Independent Payment Advisory Board, the AMA said, adding that this board needs to be overseen by Congress and have input from physicians. "The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery," according to a statement from Dr. Rohack.
He pledged that the AMA will continue to push Congress to pass a permanent repeal of the Medicare payment formula, known as the Sustainable Growth Rate or SGR: "We will hold Congress's feet to the fire on getting that done before this Congress adjourns."