Federal health reform discussions took a turn for the worse last week with the introduction of the "America's Healthy Futures Act of 2009" by Senator Max Baucus (D-MT), chairman of the influential Senate Finance Committee.

Together with the Texas Medical Association, the California Medical Association sent a letter to Senator Baucus to express our serious concerns and to urge him and his committee to work towards universal access to care for the uninsured and health care delivery reform based on proven models from around the country that work for patients and physicians in all modes of practice. Read our joint letter to Senator Baucus.

While the Baucus proposal has some positives, such as a 10 percent Medicare bonus payment to expand access to primary care and the authorization of non-profit community co-ops in lieu of a public insurance option, CMA strongly opposes many other provisions that will undermine the profession of medicine and threaten patient access to their doctors.

Initial analysis by CMA projects that the net effect of various provisions relating to Medicare payments could result in a 33 percent cut in Medicare payments for California primary care physicians and as much as a 48 percent cut in Medicare payments for specialists, depending on the region and mode of practice. Other notable shortcomings in the bill include:

• Expands the unreliable "Physician Feedback" program;
• Imposes 5% penalties on physician outliers;
• Fails to eliminate the Medicare Sustainable Growth Rate (SGR);
• Creates independent and unaccountable Medicare Commission to set Medicare policies;
• Includes an enrollment fee for Medicare and Medicaid providers;
• Fails to protect physicians from expanded liability from new clinical guidelines;
• Fails to update Medicaid physician payments;

The Baucus bill is still undergoing "mark-up" in committee, so the exact nature of the final proposal remains very fluid. The mark-up process to date has not improved the bill.

However, Chairman Baucus has committed to propose an amendment on the Senate floor to eliminate and rebase the current SGR. CMA and AMA are also exploring a floor strategy to include additional medical liability protections for physicians. As things stand now, the Baucus proposal is a tremendous step backwards for Medicare/Medicaid payment reform efforts, particularly compared to the health reform legislation moving through the House, which includes an SGR fix and Medicaid payment updates, and does not include many of the punitive measures against physicians contained in the Baucus proposal.

CMA believes that we must reform our health care system by building upon what works and fixing what is broken. Unfortunately, the version of health reform advancing in the Senate promises to undermine what is working and is based on unproven, unsuccessful models of care, while failing to address aspects of health care that need to be fixed. CMA and organized medicine will continue to advocate on behalf of patients and physicians of all modes of practice.

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