Wither Health Care Reform? 

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By Lyle Dennis, Cavarocchi - Ruscio - Dennis Associates, LLC, Consultants to AASLD

The stunning victory of Senator-elect Scott Brown in Massachusetts on January 19, depriving the Democratic Majority in the United States Senate of its sixtieth vote – the number needed to shut off debate under the Senate’s rules – has sent shockwaves through the political establishment in Washington and brought into question the future of health care reform.

Both the House and Senate have passed separate versions of the legislation – with significant differences in numerous provisions – and discussions have been ongoing for weeks to reconcile those differences into a single bill that can pass both houses and that the President can sign into law.

The loss of the Massachusetts Senate seat – vacant because of the death of Senator Edward Kennedy – changes the dynamic substantially. The Senate bill was already less far-reaching than the House bill in many provisions and still passed without a single vote to spare on a straight party-line vote. The House bill passed with just three votes to spare. Moving the bill to either the right or the left could cause Members of Congress from the opposite end of the political spectrum to drop their support.

That leaves open the question of what to do next to advance reform. Several possible scenarios have been floated:
• The House could try to pass the Senate bill exactly as it passed the Senate. That could then be sent to the President for signature.
• Both houses could consider a new bill that extracts those provisions that are perceived as relatively non-controversial from both bills (eliminating lifetime and annual caps on insurance policies; increasing reimbursement for primary and cognitive care; reauthorizing health professions training; etc.). 
• Utilizing a process under the Budget Resolution known as “reconciliation” in which those provisions directly related to budget savings could be passed and, under Senate rules, only 51 votes would be needed.

Each of these approaches presents complications from either a political or a policy perspective, and sometimes from both. The leadership of the House, the Senate, and the White House are involved in intense discussions to seek the most reasonable and productive course.

For AASLD members, the impact of health care reform passing or not is a mixed bag. For those in practice, the bonus payments for certain E & M codes are important. For health services researchers, the commitment to comparative effectiveness research is potentially large source ($600 million per year) of new research funding, although that is the only research-specific provision in the bill.

As this issue gets sorted out in Congress, AASLD will be on top of it representing the membership’s interests. In the meantime, additional issues are going to be coming up shortly.  On February 1, the President will send to the Congress his recommendations for funding for FY11. With the big increase in funding that for NIH that was included in the American Recovery and Reinvestment Act (ARRA), FY11 will be a crucial year to maintain the momentum and build on the additional capacity that has been created by that law.

At the same time, with the release of the recent IOM report on viral hepatitis, it is clear that additional funding is needed in such agencies as the Division of Viral Hepatitis at the CDC.  Working with our allies in the patient advocacy community, AASLD will be seeking a significant increase in funding for that agency.

This electronic newsletter is a bi-weekly publication of AASLD and replaces the former bi-monthly print newsletter and weekly e-news. Members are welcome to submit articles and may send suggestions to aharan@aasld.org.