After more than a year of debate, Congress is at the brink of passing historic legislation to expand health care coverage to millions of Americans.  The final legislation will contain a number of provisions that CMA has been fighting to achieve for years, such as insurance industry reforms to protect patients, measures to make coverage more affordable for low-income families, as much as $350 billion in physician payment fixes in Medicare and Medicaid, and increased funding for primary care, physician training, and wellness and prevention. Unfortunately, it will contain some provisions that CMA opposes and will require our continuing legislative and regulatory advocacy to rectify.

House and Senate leaders are meeting over the next few weeks to reconcile the remaining differences between the House and Senate reform bills. Despite these differences, we fully expect – based on our conversations with congressional leadership – that the House-Senate conference committee will have the votes to produce legislation that will pass both houses of Congress and be signed by the President as soon as the end of January.

Outstanding issues still remain that CMA believes must be addressed if the legislation is to deliver on its promise of increased access to care. Now is our last chance to improve the legislation that appears will certainly pass out of Congress. In these final weeks, CMA is focused on improving the legislation on six critical issues:

• Repealing the Medicare Sustainable Growth Rate. The current formula would cut funding by 40 percent in future years if left in place and would hurt senior citizens’ ability to find a doctor to treat them. The viability of Medicare is crucial as millions of baby boomers retire and enter the program.
• Eliminating or modifying the proposed Independent Payment Advisory Board (IPAB), which could slash spending and coverage options for senior citizens with little input from others.
• Increasing Medicaid’s low reimbursement rates. As it is, patients covered by Medi-Cal often struggle to find a doctor because rates are so low that only about one third of the state’s physicians participate in the program. Both bills dramatically expand eligibility, meaning up to 2 million more patients could enter Medi-Cal, further complicating access.
• Updating the Medicare locality system to reflect changes in practice costs;
• Ensuring that any physician quality reporting program is accurate, fair, and offers physicians an opportunity to correct mistakes in the data or process;
• Ensuring patients have the right to privately contract with Medicare physicians.

You can get more information and details in our letter to the House-Senate Conference Committee, which is available on our health reform webpage.

As historic as this legislation is, much of the work to effectively implement the legislation will occur in the coming months and years. CMA is committed to continue working with Congress, federal agencies, and regulators to ensure that this legislation doesn’t fail to deliver on its promise.

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