The ACP Advocate Blog
by Bob Doherty
Wednesday, September 16, 2009
Baucus offers plan to extend coverage, cut deficit, and increase primary care fees
Today, Senator Max Baucus (D-MT), chair of the Senate Finance Committee, released his version of health reform. ACP is analyzing the bill, so I'll have more to say about it in subsequent blogs. A few highlights, or lowlights, depending on your point of view:
The CBO projects that the bill will reduce the deficit by $49 billion over ten years, and that likely it would to continue to reduce the deficit in subsequent years.
It is financed principally by a tax on insurers who sell high cost health plans and by savings in Medicare and Medicaid. There is no direct tax increase on higher income persons, as in the House bill, although the insurance tax on high cost health plans likely would be passed onto to people enrolled in such plans.
The bill bans most insurers from excluding or cancelling insurance based on a person's health status or pre-existing condition, and limits the factors that can be used in setting premiums.
It provides subsidies for people up to 400% of the federal poverty level to buy coverage through an exchange (purchasing pool), but the subsidies are much lower than in the House bill. With the result that out of pocket costs will be much higher, especially for younger persons.
Individuals seeking subsidies or coverage through an alliance would have to submit documentation that they are in the United States lawfully.
The bill provides additional funding for states to expand Medicaid to 133% of the federal poverty level.
It does not include an employer mandate. Instead, large employers who do not cover their workers will be required to pay the costs of any federal subsidies extended to those workers.
No public option; instead, regional non-profit cooperatives are proposed to compete with private insurers.
Everyone, with only a few hardship exceptions, would be required to buy coverage.
On physician payment, it would provide only one year of relief from the Medicare SGR physician pay cuts (0.5% increase instead of a 21% cut in 2010), paid for in a way that will cause an even bigger cut the following years. Congress would then need to pass legislation next year to halt the subsequent years' cuts, at an even bigger budget price tag.
Senator Baucus proposes to give general internists, family physicians, pediatricians, and geriatricians a 10% bonus payment for designated office visits and other evaluation and management services. Half of this would be paid for with additional federal spending, the remaining by a small (half percent) across-the-board reduction in Medicare physician fee schedule payments. The House version, H.R. 3200, proposed a 5% primary care bonus paid for entirely with new federal dollars (no budget neutrality offset to other physician services).
Oh, and despite months of working to get GOP support, Chairman Baucus had to admit that as of now, not a single Republican has signed onto the bill, although he expressed confidence (hope?) that he'd have some level of bipartisan support by the time that the Senate Finance Committee takes up the bill next week.
I expect that ACP will find some things we like in the Baucus bill, but other things - especially the fact that it just kicks a solution to the Medicare SGR pay cuts down the road - are likely to be of real concern. I am interested though in readers' initial reaction to the proposal, and especially to the idea of giving primary care physicians a bigger raise, paid for in part by a modest reduction to other physicians.
Today's questions: What is your initial reaction to the Baucus plan? Is it reasonable to ask all physicians to chip in a half percent of their Medicare fees to help fund a 10% increase in designated services by primary care physicians?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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