College of American Pathologists
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March 11, 2010
© 2009 College of American Pathologists
Special Report
The Final Vote: Health Care Reform Passes in the House 219 to 212

By a vote of 219 to 212, the House of Representatives voted yesterday to approve a sweeping package of health care reforms that will include new patient protections, expand coverage and recast how medical care is provided for years to come.

The bill, H.R. 3590, the Patient Protection and Affordable Care Act, which passed in the Senate on December 24, 2009, will expand medical coverage to an additional 32 million Americans as it also seeks to improve patient outcomes and reduce health care delivery costs.

In anticipation of the bill’s passage, CAP President Stephen N. Bauer M.D., FCAP, sent a letter to House Speaker Nancy Pelosi, outlining the College’s position on issues important to pathologists and the practice of pathology.

The letter urged lawmakers to pass a permanent fix of the SGR, one of the few major issues not addressed in health care reform, and asked Congress to examine the value of an enhanced role for pathologists in coordinated care models.

“Pathologists are uniquely trained and positioned to assist in delivery system reform since diagnostic testing plays a central role in the direction and management of a patient’s care in virtually all aspects of medicine, from prevention and primary care, to cancer, chronic disease, personalized medicine and public health,” Bauer said. “In this context, pathologists not only ensure that patients get the right test at the right time, but they also protect the health care system against inappropriate requests for an ever increasing complex and expensive array of diagnostic testing.”

Key Provisions Impacting Pathologists

As previously reported in Statline, this health care reform bill will include a number of provisions impacting pathologists. Among the most immediate is the one-year extension of the technical component (TC) “grandfather”, which till take effect retroactively from January 1, 2010 – December 31, 2010.

The bill also contains initiatives to be developed or expanded over the next several years aimed at testing healthcare delivery models and reducing health care delivery costs. CAP’s letter to Speaker Pelosi addressed each of these provisions:

  • Creation of an Independent Medicare Payment Advisory Board (IPAB),
  • Expansion of the Physician Quality Reporting Initiative (PQRI) Program
  • Clinical Laboratory Fee Schedule Rate Cut
  • Increased Funding for Comparative Effectiveness Research
  • Payment for Complex Diagnostic Tests
  • Identifying Misvalued Codes
  • State Grants for Alternative Medical Liability Demonstrations
  • Physician Payment Sunshine and Self-Referral Exception
  • Establishment of a Workforce Commission

Next Steps

Shortly after voting to pass the health care reform bill at about 10:00 p.m. last night, House members voted to also approve H.R. 4872, the Health Care and Education Affordability Reconciliation Act of 2010, a smaller bill with amendments to H.R. 3590. This bill now goes to the Senate for consideration.

The Senate will be allowed 20 hours of debate and consideration of amendments to H.R. 4872 before it can be called for a vote. Senate Democrats are hoping to approve the bill before the Senate recess begins Friday, March 29. Senate Republicans have already indicated they will file a host of amendments and attempt to have specific provisions removed. This would not only potentially delay the bill in the Senate, any changes would require it to go back to the House to be voted on as amended, a tactic that could potentially derail the bill completely.

Regardless of the outcome in the Senate of H.R. 4872, President Obama has said he will sign into law the health care reform bill that has now passed in the House and Senate, H.R. 3590, possibly before the reconciliation bill has passed.

He also pledged to issue an Executive Order preventing public funds from being used to directly pay for abortions, or pay for insurance that covers abortions. This action was part of a deal the President struck with the so-called “right-to-life Democrats”, led by Rep. Bart Stupack (D-MI), who threatened to vote against the bill unless the language preventing public funds to pay for abortions was more explicit.

Once H.R. 3590 is signed into law, patients are likely to see evidence of some of the insurance reforms and consumer protections as early as this year. Most of the programs aimed at reducing delivery costs and improving quality will require several years to develop and implement. The College has prioritized its policy agenda to address near and long term initiatives, and has already begun working with Congress and regulatory agencies to help define these programs.

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