Urgent Breaking News on Medicare Payment and Health Reform -- March 3, 2010

Congress Approves Postponement of Medicare SGR Cut
Late last night, the Senate voted to extend 2009 Medicare physician payment rates through the end of the month. By a vote of 78 to 19, the Senate passed H.R. 4691, the "Temporary Extension Act of 2010," which the House approved on February 25. The bill extends 2009 Medicare physician payment rates through April 1, delaying the 21% cut in payment that was scheduled for March 1. The postponement allows time for Members of Congress to develop a longer-term resolution to the Medicare payment crisis, however proposals being circulated on Capitol Hill involve yet another short-term patch to the Sustainable Growth Rate System (SGR), including proposals to postpone cuts for 90 days, 7 months, or through the end of 2010. The APA joins the American Medical Association and the larger physician community in pressing for permanent repeal of the SGR, rather than continuing to string along physicians and their patients with short-term fixes.

The Senate is currently considering a second jobs bill, H.R. 4213, American Workers, State, and Business Relief Act of 2010, which extends Medicare physician payment rates until September 30, 2010. The bill also extends until December 31, 2010 the 5 percent bump mental health providers receive under Medicare. The provision expired at the end of 2009.

Health Reform Update
Today, the President is expected to unveil the broad outline of a second health reform proposal incorporating four areas of agreement with Republican Members of Congress, and removing any "sweetheart" deals designed to buy the support of wavering Members. A press conference at the White House is scheduled for 1:45 pm EST.

The goal for Democratic leadership and the Obama Administration appears to be enacting health reform legislation prior to the Easter recess, four weeks away. The process appears to involve the following: House approval of the Senate-passed health reform bill (H.R. 3590), followed by House and Senate approval of a budget reconciliation bill making changes to the Senate bill to bring it in line with the updated health reform plan. All three of these votes are expected to be heavy lifts, with support unlikely by Republican Members. The President hopes to bring momentum to the process through today's press conference.

In order to pass the Senate bill, the House must agree to Senate language on two lighting-rod issues: immigration and abortion. Neither of these issues can be addressed through the reconciliation process, as they have no direct budgetary impact. Particularly on abortion, the Speaker and Majority Whip, Rep. Jim Clyburn (D-SC), are expecting several Members who previously voted "yes" on health reform to switch their votes to "no" due to the Senate's less stringent abortion provisions. Ten Democratic Members in the House that previously voted "no" have indicated the possibility that they may change their votes to "yes", giving some wiggle room for attrition due to the abortion issue.

Due to the threat of a Senate filibuster, a 60-vote majority is needed to pass contentious measures in the Senate. The reconciliation process allows passage of a select set of provisions at a simple majority, or 51 votes. The reconciliation process also may be referred to as a "majority vote" or an "up or down vote." These provisions apply only to the Senate, as the House operates on a simple majority except when rules are waived due to overwhelming support.

As the situation develops, we will keep you informed. Look for a summary of the President's new proposal in the upcoming edition of RushNotes. As always, if you have any questions or concerns, feel free to contact me or my staff at advocacy@psych.org.