The U.S. House of representatives took a historic vote yesterday, passing HR 3590, the Patient Protection and Affordable Care Act, and the reconciliation bill, H.R. 4872, the Health Care and Education Affordability Reconciliation Act. After a year of contentious debate, the health care reform package passed by a vote of 219 to 212. The Senate will take up the reconciliation bill of House-Senate compromises this week.

"This legislation is a mixed bag. It includes important improvements to our health care system but falls short of actually improving access to doctors," says Brennan Cassidy, M.D., President of CMA. "Expanding coverage to more Californians, stopping insurance industry abuses, and increasing funding for primary care are much needed improvements. However, this legislation has serious flaws and omissions."

CMA strongly supports many of the bills’ provisions, including expanding health care coverage to more than 5 million California's uninsured (two thirds through private insurance), increasing Medicare and Medicaid rates by 50 percent for primary care and for general surgeons practicing in rural areas, and ending insurance company abuses by requiring them to direct 85 percent of revenues to actual patient care and prohibiting them from denying coverage to patients who become sick, who have been sick in the past, or who have chronic conditions.

While CMA supports many of the bills’ provisions, we are extremely disappointed that final reform package does little to improve overall access to doctors. Unfortunately, the bill builds health care reform on the broken foundations of Medicare and Medicaid, without adequate funding. CMA believes these programs must be fixed if seniors, military families and the uninsured are to gain access to the care they need.

CMA will be vigilant in its advocacy to improve this bill. Some of the key changes we will continue to pursue are:

• Eliminate the IPAB, an unaccountable, non-elected Medicare commission that is mandated to make arbitrary cuts that will force even more physicians out of the program and limit seniors' treatment options;
• Repeal the Medicare payment formula, which is slated to cut doctor reimbursements by 40 percent over the next several years;
• Increase Medicaid payment rates for all services and all physicians. California rates are the lowest in the nation and have driven many physicians away from the program because they lose money providing care. Half of current Medi-Cal patients cannot find a doctor;
• Update California’s Medicare geographic payment localities (GPCI); and
• Improve the quality reporting programs so that there are safeguards and due process for physicians to ensure the accuracy of the resulting data.

Regardless of your position on health care reform legislation, there is no question that our health care system will go through major changes as a result of this legislation. CMA and the physicians of California have a significant obligation to be vigilant and ensure that this legislation is implemented thoughtfully and intelligently so that it delivers on its promise of expanding access to care. This health reform legislation is an important step, but is certainly not the final step in health system reform.

To help physicians understand the reform package passed by Congress, CMA has prepared a brief summary of the legislation. (There is also a more detailed summary available for those who would like a more in depth analysis.)

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