MINNEAPOLIS, July 30, 2009 - Congressional leaders are getting the message that health care reform should not extend Medicare’s payment system and punish high-value states such as Minnesota.

On Wednesday, Democratic leaders and “blue dog” Democrats on the Energy and Commerce Committee reached an agreement about changes to the reform bill, H.F. 3200. The blue dogs, more conservative democrats, on the committee had been refusing to support the bill.

A key aspect of the agreement is that it would strip out a provision in the bill that called for the provider payments in the “public option” benefit plan to be based on Medicare payment rates.

The agreement was reached between Chairman Henry Waxman (D-Calif) and Mike Ross (D-Ark) the leader of the Blue Dog Health Care Task Force, according to an AMA breaking news announcement. Both sides agreed that payments in the proposed public plan option should be based on negotiated rates rather than on the Medicare fee schedule.

Other possible amendments to the bill include the option of establishing health insurance co-ops in addition to a public plan; allowing states to establish their own state-based health insurance exchanges, and language clarifying that participation in the public plan would be optional for physicians.

Other reported revisions to the bill include raising the small business exemption to include companies with payroll expenses up to $500,000, with tax penalties kicking in at $750,000.

Medical liability
Rep. Bart Gordon (R-Tenn) intends to offer a series of three medical liability amendments to H.R. 3200 that
• would provide new incentive payments for states that enact certain medical liability reforms,

• would limit liability for health care providers who volunteer across state lines in times of federally recognized emergencies, and

• would treat emergency room providers as federal employees when they are providing emergency care under the EMTALA law, which would result in the federal government covering the provider’s liability.


The AMA supports these amendments as incremental steps towards the more comprehensive tort reform that is needed.

Senate plan
Senate Finance Committee Chairman Max Baucus (D-Mont) and Sen. Chuck Grassley (R-Iowa) were expected to unveil an agreement Thursday about key elements of a bipartisan reform proposal, according to the AMA. Under the agreement, reform legislation would authorize the creation of non-profit health insurance co-ops rather than establishing a new public plan option and it would not impose a mandate on employers to offer health insurance coverage.

As expected, the Senate Finance Committee proposal would prevent a 21% Medicare physician payment cut that is scheduled for January 2010, but does not include a long-term replacement of the Sustainable Growth Rate formula.