Health care reform activities will be at the forefront of the legislative agenda throughout the summer. Earlier this week, President Barack Obama met with key senators and called for a final health care reform bill to be presented to him for signature by October 1, 2009. While Congress is rapidly increasing its legislative activity to meet July timelines for floor action, reform proposals must be reviewed and scored by the Congressional Budget Office, which creates delays. For more information, click here and here.

Five key congressional committees have jurisdiction over health care reform: 1) the Senate Finance Committee; 2) the Senate Health, Education, Labor and Pensions (HELP) Committee; 3) the House Energy and Commerce Committee; 4) the House Labor and Education Committee; and 5) the House Ways and Means Committee. To date, only the Senate Finance Committee has engaged in any serious activity related to health care reform, although the Senate HELP Committee is expected to release detailed plans shortly. The leaders of the Senate Finance Committee (which has jurisdiction over Medicare, Medicaid, and taxes) - Chairman Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa) - are spearheading health care reform efforts within Congress. The Finance Committee has three principal areas of focus: a) delivery systems; b) insurance coverage; and c) financing of health care. The committee has hosted a series of roundtable discussions on a number of issues. In the past month, the committee has published three separate options papers that provide broad outlines for reform:

  • Transforming the Health Care Delivery System: This options paper addresses general, big picture issues regarding Medicare payment reform. Highlights of the paper include:
    • Establishing a hospital value-based program that would move from a system of bonuses for reporting quality measures to paying for hospitals' actual performance on these measures.
    • Improving the Physician Quality Reporting Initiative (PQRI).
    • Tying reimbursement for imaging to appropriateness criteria.
    • Establish quality reporting programs for inpatient rehabilitation and long-term care hospital providers.
    • Increasing the number of primary care physicians and general surgery physicians through bonuses (potentially at the cost of specialist bonuses) and reallocating GME slots.
    • Improving care management and care coordination through various bonuses, demonstration programs, etc.
    • Reducing hospital admissions through payment incentives.
    • Bundling acute and post-acute care to force more coordination and less duplication.
    • Increasing the use of health IT.
    • Increasing comparative effectiveness research.
  • Expanding Health Care Coverage: This options paper deals with structural insurance coverage issues and the ways in which coverage can be extended to more patients:
    • Insurance Market Reforms
    • Health Insurance Exchange: All state-licensed private insurers in the non-group and small group markets, and the public health insurance option if applicable, operating nationally, regionally, statewide or locally would be required to participate in the Health Insurance Exchange. Private insurers would also be permitted to sell these policies directly to purchasers.
    • Making Coverage Affordable
    • Public Health Insurance Options
      • Medicare-like plan;
      • Third-party administrator; or
      • State-run public option
    • Role of Public Programs
    • Shared Responsibility
    • Prevention and Wellness
    • Long-Term Care Services and Supports
    • Options to Address Health Disparities
  • Financing Comprehensive Health Care Reform: This options paper focuses on increasing payment accuracy and reducing disparities in payment and spending amounts among different geographic regions across the country. The paper also addresses tax provisions that promote wellness and healthy lifestyle choices, as well as proposals President Obama included in his budget:
    • Options for financing health reform include:
      • Health system savings
      • Changes to current health care tax expenditures
      • Lifestyle tax proposals
      • Revenue provisions in the Administration's budget
    • Ensuring appropriate Medicare/Medicaid payment. Options include:
      • Updating payment rates for home health services
      • Adjusting hospital DSH and GME payments
      • Reducing overpayments to Durable Medical Equipment (DME) suppliers
      • Adjusting reimbursement for high-growth, overvalued physician services (e.g., imaging, minor procedures)