College of American Pathologists
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March 19, 2010
© 2010 College of American Pathologists
Special Report
Health Care Reform Comes Down to
the Wire
Reconciliation Bill Introduced
House Vote Scheduled for Sunday, March 21

The House Rules Committee yesterday released the health care reform reconciliation bill H.R. 4872, The Health Care & Education Affordability Reconciliation Act of 2010, and started the clock on the 72-hour waiting period before it can be brought to a vote in the House of Representatives. The House vote is scheduled for Sunday, March 21.

The reconciliation bill amends the sweeping health care reform legislation H.R. 3590 – the Patient Protection and Affordable Care Act, passed in the Senate on December 24, 2009. Democrats hope this will bridge differences between House and Senate versions of the bill and allow for a completed overhaul bill to be approved and sent to the President to be signed into law.

If the reconciliation bill passes in the House, it will go on to the Senate for consideration. Washington insiders predict the process will slow considerably in the Senate where members from both parties are permitted and expected to introduce amendments to the bill within a 20-hour debate window. If the legislation is changed in the Senate, it would have to go back to the House for another vote.

The Senate-passed health care reform bill did not include a fix of the Sustainable Growth Rate formula used to calculate Medicare physician payment. However, this legislation does include a one-year extension of the TC “grandfather” provision, starting retroactively from January 1, 2010 – December 31, 2010.

House Democratic leaders hope to pass the Senate bill on Sunday along with separate changes contained in the reconciliation bill.

Together, the revised bill would extend coverage to 32 million Americans by expanding Medicaid eligibility, creating state-operated health insurance exchanges and providing federal subsidies for those lower-income families who cannot afford to purchase insurance and do not have coverage through an employer Although proposed changes in the reconciliation measure include scaling back the tax on high-cost insurance plans, a new Medicare tax on net investment income will be added on high-wage earners Some health-related tax deductions will also be tightened.

Many of the bill’s delivery system reforms that could impact pathologists were familiar, having been launched through previous Congressional action and moved forward in the health care reform bill. The College has been working on these programs for some time and was able to achieve a number of successes in the bill.

The College worked with the AMA and other physician specialties to ensure that bonus payments for primary care physicians would not be paid for by cutting payments to specialists. CAP secured an extension of the TC “grandfather”, and as a member of the Clinical Lab Coalition, successfully blocked a proposed tax on clinical lab revenues. The College also ensured that all laboratories, not just commercial labs, would be able to participate in a demonstration project that would allow Medicare to pay labs directly for certain molecular tests, rather than be paid through the DRG. Language was included that could allow pathologists to receive bonus payments using alternative ways to measure performance under the current pay for performance program, and language was included to help crack down on violations of the Stark law, such as abusive in-office pathologist arrangements and POD labs.

The CAP will continue to work to address remaining concerns as Congress, in its oversight role, monitors implementation of health care reform. Advocacy staff will also be turning our attention to the regulatory arena as regulations to implement the bill get underway. In a letter to House Speaker Nancy Pelosi, the College outlined several issues on which improvements are sought. These include:

  • Granting authority to an Independent Payment Advisory Board that would shift responsibility for Medicare coverage and payment decisions to an unelected body in the Executive Branch.
  • The creation of a two-year demonstration project permitting certain qualifying molecular tests to receive direct payment from Medicare, rather than through the DRG. CAP fears this provision hampers innovation and competition in the growing field of personalized medicine because the criteria to qualify largely favors a select group of commercial laboratories to the detriment of independent laboratories and academic medical centers.
  • Payment penalties for not meeting performance measures under the Physician Quality Reporting Initiative (PQRI).
  • Requirement for the HHS Secretary to identify and adjust misvalued codes using existing and new processes for recommendations.

The next milestones for tracking health care reform legislation will be the vote in the House on Sunday, followed by consideration of the reconciliation package in the Senate. (Read a detailed explanation of the deliberation process.)

Although some suggest the House does not have the votes to pass the measure, others believe they will indeed have the votes, even if by a razor-thin margin, come Sunday. That will allow the President to first sign the Senate health care reform bill into law. Should the Senate successfully pass the reconciliation measure, the President would then be able to sign into law additional changes to the Senate bill. The Senate could begin consideration of the House reconciliation bill next week.

For more information on the reconciliation bill, read the section by section analysis prepared by the House Committees on Ways & Means, Energy & Commerce, and Education & Labor, and released by House Rule Committee Chairwoman Louise M. Slaughter on March 18, 2010.

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