Health Care Reform Schedule and Medicare

If email messages I've been getting is an indication, some people are confused about the process of the health care reform in Congress. A couple of them seemed to think that the bill passed by the Senate Finance Committee last week was the final bill. Not so, as many who read this blog know.

On Friday, several other elderbloggers and I had another telephone conference call with aides to Senate Majority Leader Harry Reid in which we discussed the schedule for a final Senate bill and some Medicare issues.

Senate Health Care Reform Bill
The next step is to combine the two Senate bills – the HELP bill from the Health, Education, Labor and Pensions Committee and the Baucus bill from the Senate Finance Committee. Work on that merger begins this week and on an optimistic timetable, will be finished by Friday 23 October.

The biggest difference between the two bills is the much-argued public option provided for in the HELP bill but not in the Baucus bill.

Whether a combined bill emerges on Friday or later, the bill must then be scored (calculate the cost) by the Congressional Budget Office (CBO), a task that may take two weeks. Senator Reid's aides predict that it should be done by early November. Then it goes to the Senate floor for a vote.

Given the glacial speed at which Congress ordinarily moves, along with whatever monkey wrenches various senators may throw into the negotiations, my estimate is by Thanksgiving. When I suggested this to Senator Reid's aides, they said they believe that would be the latest date.

Meanwhile, the three reform bills in the House must go through the same merger, scoring and vote procedure.

Then, those two bills go to a conference committee of the two houses of Congress from which one final health care reform bill emerges. (CSPAN may broadcast the conference committee which should be fascinating to watch.)

Maybe I'm just a pessimist, but I don't see how there can be a bill on the president's desk, as Obama wants, by the new year. I think very early in 2010 is more likely but I could be wrong...

Medicare Physician Payments Over the years here at Time Goes By, I've heard from readers who are Medicare beneficiaries that they have been “fired” by their doctors or that they have had trouble finding a physician who will take new Medicare patients. A lot of this has to do with physicians' pay.

As the current law stands, beginning 1 January 2010, physicians will see a 21.5 percent pay cut for their Medicare patients. And according to a 2007 study, Medicare payments to doctors were then 20 percent below what private insurers pay. In another 2007 study, from the American Medical Association, 60 percent of physicians said they would limit the number of new Medicare patients with only a ten percent cut.

Faced with a growing elder population (the oldest boomers will become eligible for Medicare in 2011) and the need for more Medicare physicians, Congress intends to do away with the pending 1 January 2010 cut, which should happen this week. New and more reasonable payments for Medicare patients will be forthcoming in the final Senate version of the health care reform bill, according to Senator Reid's aides.

Contacting Your Senators
Although I mentioned this a week or two ago, it bears repeating. The senator's aides tell us that our phone calls, email and letters to our Senators count a great deal. They are tallied and tracked and discussed with senators' offices. And multiple contacts from us help.

So make your positions on health care reform known to your senators, and keep doing it. You can contact your senators here.

At The Elder Storytelling Place today, William Weatherstone: Alzheimer's: Part 8 – The Final Day

Comments

[Darlene]

After listening to Rahm Emanuel on TV yesterday I was discouraged to discover that, although he prefers is, President Obama will not be pushing for the public option. Now it will be up to those Senators like Jay Rockefeller to fight for it.

Unless the voters makes a loud and continuous demand I greatly fear the public option is dead. This means that insurance premiums will continue to rise and, while nearly everyone will be insured, the big elephant in the room will just get bigger.

What a tragedy if this opportunity goes by without real reform.

[janinsanfran]

I fear Darlene is right about this: if we want a public option -- that is, a government plan that forces insurers to compete, instead of being free to jack up rates -- we have to keep pushing our Senators.

[Robert Weise]

As a student studying gerontology with more than a few concerns about the health care reform debate, I was pleased to read your post about the issue. I'm glad you decided to set the record straight and give some important details about the issue as it stands now so avid bloggers could learn a thing or two about a crucial topic that far too many people know far too little about. There is particularly a lot of confusion about the oft debated public option with some of the fiercest fighting settling squarely on this particular piece of the reform puzzle. I know many people believe the public option is off the table and others believe it is still kicking so I was glad you clarified the ongoing discussion about whether or not the public option will be included as the HELP bill and the Baucus bill collide this month. I personally believe the President will forgo the public option route to win more blue dog support (since bipartisanship hasn't seemed to really work thus far), but there are no guarantees; it was helpful for you to really lay the facts out there so other people can see the issue is far from decided and understand how the process will move forward. I also enjoyed your bit about the Medicare reimbursement angle of the debate because this area is also very unclear to many Americans. It is important to know where doctors stand on this issue and what the reforms are poised to do to address this debacle. My father is a doctor so I personally have been keenly (and at times uncomfortably) aware of what the medical community feels about the issue, but most Americans are not so fortunate so your post really does wonders in this regard as well.

I was curious what your experience was like talking with aides to Senate Majority Leader Harry Reid about the issue. Did you get a positive vibe from them about the timetable, or was there a significant degree of uncertainty? Also, did you get the impression that the Congressional Budget Office phase of the process would be a stumbling block for the fledgling legislation or are you more inclined to worry about conference committee really putting a freeze on the whole deal? I am also interested in your impressions about the medicare portion of your conference call; How confident were the aides about the "new and more reasonable payments for Medicare patients" and how do you personally feel about this part of the proposed bill? Do you believe doctors will be placated by this proviso or will it simply be a gesture of little significance to them? Anyways thank you for your lovely post and here's to the hope the outcome is the best for older Americans and those concerned about our graying society.

[joared]

Thanks for the current up date. Glad you and others are still having contact with Sen. Reid and they're listening.

I, too, don't feel real confident about a public option being part of any final bill that might be passed. What that means is that just as Wall St. is back to distributing excessive profits with little regulation having been formulated, the health insurance companies, pharmaceutical companies are going to continue contributing mightily to out of control health care costs. If such a bill takes effect, many voters will complain eventually, then conclude health care reform ineffective and too costly -- all because the reform wasn't done properly in the first place.

I think the cut in pay to doctors will result in pass through charges with the individual patient being billed increasing amounts over and above what Medicare plus supplemental insurance limits will pay. That has been happening to me for some time beginning a coouple years or so ago when suddenly I received a doctor bill retroactive for amounts from the preceding two or three years. I thought when doctors accepted Medicare assignments they were automatically agreeing to abide by a total charge limited to what Medicare determined was a designated fee. But, after Medicare pays, and my supplemental insurance then pays another amount, the doctor bills me for even more.

We've taken cuts in service payments in my profession beginning several years ago but we don't bill patients for an amount over and above what Medicare and insurance pays.

I've phoned my Representative in D.C. and was able to leave a verbal message expressing my wish he would act positively on health care. Unfortunately, he's part of the Republican block who are likely to vote against meaningful health care reform and for insurance companies. He chooses to believe his constituents think as he does despite evidence to the contrary.

Even though many of us agree it appears bleak for a public option, much less a single payer system, this is a time when we all need to be making our views known repeatedly to our Congressional Reps. and Senators.