Healthcare Update 12.18.09

The fun continues!

The House voted this week to pass an amended defense appropriations bill (H.R. 3326), that temporarily delays the scheduled 21.2% Medicare physician payment cut that was set to occur January 1st. Congress now has until Feb. 28th to come up with a plan to keep these cuts from happening. The bill provides a 0 percent update to the Medicare physician payment formula to allow Congress to establish a new permanent Medicare physician payment system upon returning in the new year. The Senate is poised to approve the defense spending bill in the coming days. Both the House and Senate tried to include a permanent fix in their healthcare reform proposals to the Sustainable Growth Rate (SGR), which is the reason these Medicare cuts were set to occur in the first place, but due to the fiscal impact of fixing the SGR, neither healthcare reform proposal addresses this issue.

The Senate will begin working on the healthcare reform bill again this weekend and there is still talk that something will be voted on by Christmas. What that "something" is remains to be seen.......
Stay tuned......

Senate Health Reform Vote by Christmas in Doubt....

Kaiser Health News has pulled together news articles from across the country regarding the issues that the Senate still faces in trying to get a vote on healthcare reform prior to Christmas next week.

Please click HERE to read up on the obstacles the Senate is facing in reaching its deadline.

Senate Healthcare Reform Update - 12.16.09

Senate Majority Leader Harry Reid (D-Nev.) and the White House are still negotiating with key senators to reach agreement on outstanding issues so a manager's amendment can be finalized this week. This amendment is being designed to garner the 60 votes needed to pass H.R. 3590, the "Patient Protection and Affordable Care Act," before the holidays. So far, more than 430 proposed amendments to the bill have been submitted, although only a handful will be presented for a vote on the Senate floor.
A proposal circulated last week that would have allowed uninsured individuals between the ages of 55 and 64 to purchase Medicare coverage has been abandoned after generating opposition from centrist Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), as well as from a group of Democrats representing states with relatively low Medicare payment rates.

It remains to be seen if there will be a vote before Christmas as originially planned. Stay tuned.......

Some Rural Communities Concerned Reform Provisions Could Hurt Medicare Services

Newspapers in Alaska and Washington state explore how health reform provisions might affect Medicare services in rural areas, while a Colorado newspaper looks at one senator's efforts to increase the number of doctors in rural areas.

Please click HERE to read these stories in their entirety.

12.9.09 - Healthcare Reform Update

The fun continues as the Senate moves into its 10th day of the healthcare reform debate. As of this writing, Senate Majority Leader has pulled the public option and has offered a compromise instead. The compromise consists of offering a private plan that is similar to the Federal Employee Health Benefit plan, which is the plan offered to members of Congress. The compromise also would allow those who are uninsured and between the ages of 55 - 64 years old to buy into Medicare. Even with this compromise being offered, there are some Senators who are still talking of allowing a "trigger" for a public option that would come into effect by a certain date if this compromised plan does not alleviate healthcare costs and reduce the number of uninsured.

There are still numerous amendments, including rural provisions, that have been officially filed, but not yet brought to the floor. There is no distinct timeline as to when the rural amendments will be offered, though Senator Reid is still claiming the Senate will have a complete bill before Christmas. Stay tuned.........

Critical Access Hospitals and Healthcare Reform

Critical Access Hospitals not only play a vital role in providing healthcare services to our rural and frontier counties, but they are also a main ecomonic driver in rural communities. The Patient Protection and Affordable Care Act does not adequately address some key provisions that would help increase the ability of CAHs to offer quality, comprehensive healthcare services. Now is the time to contact your Senators to ensure all of the following are addressed:

Reinstate "Necessary Provider" for Critical Access Hospitals - This would allow states to once again waive the 35-mile requirement and deem a hospital as a "necessary provider" based on unique conditions often only realized by local and state entities.

Allow Critical Access Hospitals flexibility in their bed count - CAHs currently are limited by a hard 25-bed cap. Allowing CAHs to maintain an average bed count of 20 improves patient access, especially in the case of seasonal or other unexpected influxes of patients.

Ensure Rural Access to Anesthesia Services - CAHs frequently use certified registered nurse anesthetists to provide anesthesia services in a cost-effective way. However, Medicare reimbursement is currently unreliable due to a lack of clarity in current legislation. Current legislation (S. 1585) would solve this problem and must be included in the final health reform bill. Additionally, H.R. 3151 seeks to close current loopholes and ensure that Critical Access Hospitals (CAHs) are properly reimbursed for their anesthesiology services.

Eliminate CAH "Isolation Test" for Ambulance Reimbursement - Under current law, CAHs can only receive cost reimbursement for ambulance services if they are the only provider of ambulance services within a 35-mile drive. This provision would eliminate the 35-mile requirement, ensuring that CAHs are appropriately reimbursed for providing emergency medical services.

To contact Senator Bennet click HERE or call: 202-224-5852
To contact Senator Udall click HERE or call: 202-224-5941

Senate Healthcare Reform Update

The Senate is currently debating H.R. 3590, the Patient Protection and Affordable Care Act. As of Sunday evening, a total of 165 amendments had been formally submitted, the vast majority of which will not be voted upon. There are many rural provisions that have been submitted, though it is unknown when or if these amendments will be voted on. Colorado's Senator Bennet has submitted an amendment entitled the Rural Health Access and Improvement Act, which would prioritize Critical Access Hospitals to receive grants to implement Health Information technology, expand participation in Drug Pricing Agreement program under Section 340B of PHS Act, provide for a study and report on Pharmacy Dispensing Fees under Medicaid, and provide continuing funding for the State offices of Rural Health. Colorado's Senator Udall also plans to submit an amendement that would create a grant program for medical schools to offer Rural Training Tracks, which encourages and trains medical students to practice medicine in rural areas.

Stay tuned for more updates as the Senate is expected to continue debating the healthcare reform proposal and the plethora of amnedments throughout the next few weeks. You can also visit the National Rural Health Association to stay on top of current healthcare reform news.

Senate to Begin Debating Healthcare Reform on Monday, November 30th

After months and months of waiting, the Senate finally has a healthcare reform proposal, The Patient Protection and Affordable Care Act, that will begin being debated on Monday, November 30th. The Senate voted this past Saturday to invoke cloture and had the magic number of 60 votes, which means there is no opportunity for those opposed to the legislation to filibuster. It also means there will eventually be a floor vote in the Senate. When that will occur and how the bill will look by the time a floor vote comes; remains to be seen.

There are many rural provisions and amendments that our national partner organization, the National Rural Health Association, hope are added to the Senate bill. For a specific list of these rural provisions, please click HERE.


Now is the time to contact Senator Udall and Senator Bennet and urge their support for these rural amendments.

I'd like to contact Senator Udall.
I'd like to contact Senator Bennet.

House Passes Medicare Fix for Physicians

The House of Representatives passed HR 3961 yesterday (11.19.09). This bill eliminates the 21% cuts to Medicare Payments that would have started in January and provides a long term fix for the Sustainable Growth Rate formula. The bill passed by a vote of 243 to 183. Colorado's Democratic Representatives voted in favor of this legislation, while the two Republican Representatives (Lamborn & Coffman) voted no.

Even though this legislation has passed in the House, its outlook in the Senate remains in doubt. Though the Senate's most recent health reform bill holds off the 21% cut from this year, it offers no long-term solution to this problem; but rather simply prevents cuts from taking place this January.

Stay tuned......

Senate Bill is finally (maybe) Moving Forward

Finally, the wait is over. The long-anticipated Senate health reform bill (a bill blended from the two bills reported from the Finance Committee and Senate HELP Committees) has been filed. The bill number is HR 3589. It is over 2,000 pages, so not a quick & easy read! It is believed that most of the rural provisions that were gained during the Senate Finance Committee debate are still included. Preliminary discussions of the bill have begun on the Senate Floor - - but there will be a few procedural hurdles that must be overcome before we get to the actual debate where amendments will be offered.

The bill has been scored by the Congressional Budget Office (CBO) at $849 billion over ten years, ie, within the target that the Democrats were shooting for. CBO indicates that the bill will actually reduce the deficit by $127 billion over ten years and $650 billion over the following ten years. The bill is also projected to insure 94% of the population.

As of right now, it looks like the Senate will work on procedural maneuvers through the weekend. Majority Leader Reid will file a procedural motion know as “cloture” today. The purpose of the vote is to end current debate and allow a motion to proceed to the health reform bill -- the first of these two procedural votes will be Saturday and the second will be Sunday. However, this is very fluid and may change. One current roadblock that may delay this strategy is that Senator Baucus (D-MT) is in Montana due to a family matter - - if he is unable to return for the weekend votes, it will be delayed.

If 60 votes can be gained in the motion to proceed, the Senate rules then require the Clerk to read the bill. It is standard operating procedure that this perfunctory move is waived - - however, because we anticipate a Republican filibuster, the motion to waive the reading of the bill is expected to fail. This will require the Clerk to read out loud the full 2000+ page bill - - which could easily take until next Wednesday. The Senate will then be in recess on Thursday and Friday for Thanksgiving. This means that actual debate will not begin until the following Monday (November 30).

Thanks to our friends at the NRHA for providing this information. Stay tuned for more up to the minute information as it becomes available to us!

Center for Rural Affairs - Health Reform Reports

The Center for Rural Affairs recently highlighted some reports that specifically address how health reform will impact rural America. Please click HERE to access the reports in full.

H.R. 3962 - How Will the House Reform Bill Impact My Community?

The Committee on Energy and Commerce prepared, for each House member, a district-level analysis of the impact of House Bill 3962: Affordable Health Care for America Act. This analysis includes information on the impact of the legislation on small businesses, seniors in Medicare, health care providers, and the uninsured. It also includes an estimate of the impacts of the surtax that will help to pay for the legislation.

You may access this information by clicking HERE.

House Passes Health Care Reform Bill

On Saturday, the House passed the Affordable Health Care for America Act (H.R. 3962) with a vote of 220-215. Even with the passage of the House bill, overall healthcare reform has some hurdles to clear. The Senate bill is still awaiting a score (cost) from the Congressional Budget Office (CBO). Once the CBO provides its analysis, the Senate will have a floor vote, which will most likely be contentious. If and when the Senate passes its reform bill, the House and Senate reform proposals will have to be merged before anything is sent to the President to sign.

To learn about the key points of the Affordable Health Care for America Act, please visit The Kaiser Family Foundation.

Stay tuned......

Health Reform Update 11.4.09

National health reform is still moving along, though where it is going to end up still reamins to be seen. Here is a quick update on both the House and Senate side as to where the two proposals stand......

House: The House has merged the three committee proposals that were passed this summer and the total price tag of the compiled House bill is close to $1 trillion dollars, according to the Congressional Budget Office. There are still some sticky issues in the House proposal that are being worked out and a floor vote is expected this Saturday, November 7th. Some key rural health provisions are not included in the House bill and it is unlikey that there will be many (if any) floor amendments offered. This means the Senate is the key focus of adding any rural health provisions. Some of these provisions include: improving reimbursement for Rural Health Clinics, allowing Critical Access Hospitals more flexibility with their bed count (currently capped at 25 occupied beds per day), and allowing CRNAs to be reimbursed at cost through Medicare.

For a complete list of the rural health amendments that are hoping to be addressed on the floor of the Senate, please visit the National Rural Health Association Health Reform page.

Senate: The Senate has compiled both proposals that were passed this summer/fall and have sent their bill to the Congressional Budget Office (CBO). The CBO will analyze the bill and provide a price tag to the proposed reforms. It is still unknown when the Senate will have a floor vote on their reform bill and there is talk it may be pushed into 2010.

Keep checking back regularly for updates!

Expanding Health Insurance Coverage for Rural Residents through Health Reform

The Rural Policy Research Institute recently released a report entitled "Assuring Health Coverage for Rural People," which was funded by the Robert Wood Johnson Foundation. The Health Reform brief suggests that the challenges that rural people face in obtaining health insurance are partly due to the structure of the rural economy: 64 percent of adults working in rural are employed in jobs where health insurance is provided, compared to 71 percent of their urban counterparts. At the same time, rural workers are far more likely to be self-employed. Rural businesses also pay higher premium costs than urban businesses for similar health insurance plans.

Please click HERE to access the report.