House Democratic leaders unveiled their latest version of health reform last week, in HR 3962, "America's Affordable Health Choices Act of 2009" and HR 3961 "Medicare Physician Payment Reform Act of 2009." These bills are a combination of the three versions of HR 3200 that had passed out of the Ways and Means Committee, Energy Commerce Committee and the Education and Labor Committee.

CMA is still reviewing the bill, but will likely continue to support some provisions and oppose others. CMA is continuously working to improve the bill and indeed, several improvements were made to HR 3962 (see below).

The two bills continue to include the $400 billion in physician-related payment fixes for Medicare and Medicaid services, including a repeal of the Medicare sustainable growth rate formula, increases for primary care physicians and the California geographic locality payment fix. House leaders were forced to move the physician payment provisions to a separate bill because President Obama asked that the health reform bill not increase the deficit. By doing so, the remaining health reform provisions come in well under the $900 billion limit set by President Obama and would reduce the deficit by $30 billion over 10 years.

Other notable changes include a new "millionaires tax" that would tax couples with gross incomes above $1 million at a rate of 5.4 percent to help pay for health reform. The bill also repeals anti-trust exemptions for the health insurance industry and clearly prohibits the use of "comparative effectiveness research" to make coverage or payment decisions or to interfere with the physician-patient relationship.

HR 3962 also expands the Medicaid program to cover families making up to 150 percent of the federal poverty level ($33,000 for a family of four). HR 3200 only covered families up to 133 percent. CMA supports this coverage expansion, but is strongly advocating that Medicaid payment rates must be raised so that this promise of coverage is not an empty one. While the bill does increase Medicaid payment rates for primary care physicians, we believe that specialty rates must also be raised.

The House reforms remain more favorable for physicians than the Senate reforms. CMA will continue to fight to improve both bills, and to ensure that the physician-friendly provisions in HR 3962 do not get lost when these bills get to conference committee.

Most predictions are that health reform will happen this year. Physicians must let Congress and the public know that the coverage expansions are an empty promise unless patients can find a doctor.

For more information, see CMA's health reform page.

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