The ACP Advocate Blog
by Bob Doherty
Tuesday, March 16, 2010
How should Congress choose?
By this time next week, we will probably know if health care reform will be signed into law. All indications are that the House will vote on the final legislation on Friday or Saturday. The vote will essentially be on the bill that passed the Senate on December 24, with modifications to be made in a side-car "corrections" bill that can be passed by a simple majority using budget reconciliation.
The process and procedures will be messy, but today, I want to talk about substance. Does ACP believe that the Senate bill, as it will be modified by the corrections bill, deserves a "yes" vote in Congress?
ACP has determined that it does, because in most respects, the legislation is closely aligned with ACP policies developed over many years in a series of position papers.
On coverage, we have long advocated for policies to make affordable coverage available to the vast majority of Americans. We support providing sliding-scale tax credits to help businesses and individuals afford coverage. We support creation of health exchanges to offer one-stop-shopping for qualified health plans and to negotiate affordable premiums with participating plans. We support making all persons up to 133 percent of the Federal Poverty Level eligible for Medicaid. We support increased Medicaid "matching funds" to all states to finance most of the cost associated with such expansion. We support requiring all health plans to provide affordable and non-discriminatory coverage to people with pre-existing conditions. We support requiring all health plans to provide essential and evidence-based benefits including preventive services.
On workforce, we advocate for policies to train more primary care physicians and to reform payment policies to support the value of primary care. We support increased funding for the National Health Service Corps and Title VII health professions training programs. We support creation of a national workforce commission. We support providing eligible primary care physicians with a 10% Medicare bonus on all of their office, nursing home, home health care, and emergency room services, as a first step toward addressing payment disparities.
On delivery system reform, we advocate for accelerated pilot-testing of innovative payment and delivery system reforms, including Patient-Centered Medical Homes. We support funding of more research on comparative effectiveness to inform clinical decision-making.
ACP's support is based solely on how closely the legislation aligns with policy, not the process or politics selected to move it across the finish line.
This doesn't mean we like everything in the legislation. It doesn't go far enough on addressing the crisis in primary care, or in reforming the medical liability tort system. It doesn't give Congress enough control over the recommendations of an expert Medicare payment advisory group. Congress still needs to come up with a permanent solution to the Medicare (SGR) physician payment cuts. These, and other needed improvements, can and should be made in subsequent legislation.
But at this, the final stages of the legislative process, the decision is a pretty simple one. Does the legislation advance the policies that ACP has long championed in our own policy papers? We believe that it does, and tomorrow, ACP will be joining with more than 200 national health organizations to urge that Congress vote "yes" on the final health reform bill.
Should Congress fail to pass health reform, ACP believes that we will be looking at a future - as documented in ACP's recent State of the Nation's health care paper -- where health insurance premiums will double, putting health insurance out of reach of most middle class families, where Medicare will go broke, where one out of five us will have no insurance coverage, and where insurance companies will continue to reject people because they change jobs or get sick.
I know that some of you will see the choice differently. But ACP has made its choice: this legislation, although imperfect, will advance ACP's key policies, and is far better than alternative of once again seeing health reform fail.
Today's question: How do you see the choices facing Congress?
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
- March Madness
- Is lack of coverage an inconvenience? Or matter o...
- What does the American public really want?
- What's so funny about health care reform?
- Reconciliation (n), rapprochement, the reestablish...
- Should physician anger be directed at denying care...
- Jim Bunning throws doctors a curve ball
- On blogging . . .
- "We can work it out"
- What my morning commute says about the coming debt...
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.