James Geiger MD – Physician, Author and Wellness Specialist

Early this morning, the Senate took the first of three procedural votes on the Patient Protection and Affordable Care Act (H.R. 3590), successfully voting to end debate on the manager’s amendment on a 60 to 40 party line vote.  A vote on final passage of H.R. 3590 is scheduled to occur the evening of December 24th and expected to pass by an identical vote margin.  The manager’s amendment, introduced by Senate Majority Leader Harry Reid (D-NV) on December 19th, did address some of the significant concerns that the American College of Surgeons and the surgical societies have continued to raise in discussions with Senate leadership including:

* Removal of the Medicare buy-in plan;
* Removal of the application of budget neutrality for bonus payments for primary care physicians and general surgeons;
* Removal of the five percent cosmetic surgery tax;
* Removal of the Medicare physician enrollment fee.

While there were positive changes, ACS leaders evaluated the complete revised proposal (as all previous proposals) using the ACS core principles (developed by the Regents and Governors) which are quality and safety, patient access to surgical care, medical liability reform, and reduction of health care costs.  The American College of Surgeons leadership has consistently maintained in face to face meetings with Senate leadership that ACS top priorities included a permanent fix to the SGR and the opposition to the Independent Medicare Advisory Board.  To date, neither of these issues have been appropriately addressed and therefore the ACS has not changed our current position of opposition to the bill.  In addition, despite continuing efforts by College staff and leadership, the Senate bill fails to appropriately address the issue of medical liability reform.

As you know, Congress temporarily halted the 21 percent cut in the Medicare conversion factor that is scheduled to take effect on January 1, 2010 last week with a 60 day freeze of the current conversion factor. However, the College has not received any indication from Senate leadership of a pathway for permanent reform of the physician payment system, which must include resetting the sustainable growth rate (SGR) baseline and repealing the SGR formula.  In addition, the College remains opposed to the creation of IMAB and the manager’s amendment broadens the scope of the board to include non-federal health programs (although non-binding) and still exempts hospitals from the cost-containment mechanism.

Upon the Senate’s final passage of H.R. 3590, the House and Senate leadership will immediately begin reconciling the differences between the two bills in a conference committee.  Those negotiations are expected to continue through the first full week of January.  During this process, the College will continue to vigorously advocate for the removal of IMAB and a clear and viable pathway for a permanent repeal of the SGR.

Our efforts will continue to be based on our core principles and aimed at helping create a health care system in this country that is sustainable and has a surgical workforce to provide the highest quality care for our patients.

We will continue to keep Fellows updated as additional details emerge on the health care reform debate over the next several weeks.  If you have questions, please contact the College’s Division of Advocacy and Health Policy in Washington, D.C. directly at 202.337.2701.