House Health Reform Proposal Would Eliminate Medicare SGR; Physicians Urged to Tell Congress Not to Make Empty Promises
[Posted 06/15/09]

This week, the three House Committees with Health Reform jurisdiction jointly released a general outline of their health reform proposal. Most significantly for physicians, the House proposal would eliminate the sustainable growth rate (SGR) payment formula, which has been an enormous hurdle in our fight to raise Medicare physician payment rates.

The proposal would also, among other things:

• Increase reimbursement for primary care E&M services by up to 15
  percent (3 to 5 percent per year for three years);
• Allow physicians to organize into virtual or real groups to coordinate care and receive bonus payments for reducing unnecessary hospitalizations;
• Expand the Medicaid program to cover more low-income families;
• Increase Medicaid rates to Medicare levels for primary care services;
• Require everyone to have health coverage. It also provides tax credits and subsidies to families up to 400 percent of the federal poverty level to help them purchase insurance;
• Require medium and large employers to offer health insurance to their employees or pay into a fund on behalf of their uncovered workers; and
• Create a national health insurance exchange.

Although CMA strongly supports health coverage expansion and insurance market reforms (such as limits on medical loss ratios) called for in this proposal, the association is concerned that these reforms will be illusory if they don’t also guarantee meaningful access to doctors. CMA is urging physicians to contact their representatives in Congress and tell them that they must increase all Medicare and Medicaid reimbursement rates. Without these important rate increases, the promise of access to care for California’s uninsured will be a false one. The uninsured may be given health insurance coverage but they may not be able to find a doctor to care for them.

The House proposal also establishes a national health insurance exchange, through which the uninsured (and only the uninsured) can purchase insurance. The exchange would include both private insurance plans and a new public government-run plan. While specific details were not provided, it appears that the House proposal may require all participating Medicare physicians to also participate in the new public plan. While CMA understands that House leaders are concerned about building an adequate physician network to compete with the private health plans, CMA vigorously opposes mandatory participation in any health insurance plan. CMA also believes that any government plan must be adequately financed to ensure appropriate access to care.

• Representatives Contact Information

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.