Public Policy Update
By Lyle B. Dennis
AASLD is, first and foremost, a scientific society. The Association’s government relations program has focused largely on biomedical research-related issues, which is most often defined as annual funding levels for the National Institutes of Health and, sometimes, the Department of Veterans Affairs Medical and Prosthetics Program or other programs.
Increasingly in recent years, however, the Public Policy Committee, in coordination with the Training and Clinical Policy Committee, has become more involved in issues related to physician practice and payment. And, in 2009, that brings us into the middle of the largest legislative initiative that we are likely to see: health care reform.
There are several factors driving health care reform. First, approximately 16 percent of the population is uninsured. That does not mean they are untreated; it means that they show up in emergency rooms and receive the most expensive form of care – usually after their afflictions are pretty far advanced.
Second, total spending on health care is now $2.3 trillion, which is 16 percent of the gross domestic product (GDP). And, it is projected that this spending will grow to 20 percent of GDP by 2019.
Finally, health care reform has become a defining issue for Democrats in much the same way that tax cuts are an article of faith for Republicans. But, of course, with health care reform – like tax cuts – the devil is in the details.
The President and Congressional leaders are keeping the pressure on to produce a health care bill by the end of the year. The President’s very high popularity level has given him tremendous amounts of political capital to spend. And, Congress is, as always, nervously eying next year’s mid-term election and hoping to show a major legislative victory.
So, how do they get there?
In June and July, in both the House and the Senate, we can expect significant efforts to be made to produce bills and pass them. In the House, three committees have jurisdiction over parts of health care reform: Ways and Means; Energy and Commerce; and, Education and Labor. They are expected to produce a single bill. In the Senate, the Finance Committee and the Health, Education, Labor and Pensions Committee will each produce their own bills and then work to combine them by amendment during floor debate.
If both houses are successfully able to pass the bills, they will create a conference committee to work out the differences between them during September and October with a goal of bringing a final product to the floor in October. If that were to pass, the President would reach his goal of signing the bill into law before the end of the year.
Of course, it is much easier to describe goals than to achieve them. And there will be many issues in this debate that will be highly contentious, any one of which could derail the efforts to pass this legislation. Among the most controversial provisions to be decided are:
• How should physician payments be allocated? Can more money go to primary care without cutting into specialty care, and what will be the split between procedures and cognitive services?
• Should individuals be required to have health insurance (in much the same way that states require individuals to have car insurance)?
• Should businesses be required to provide health insurance to their employees or pay a fee to the government if they opt not to provide insurance?
• Should there be a “public option,” a government-run insurance option that would compete with private plans as a means to pressure them to keep costs down?
• Should the government fund comparative effective research and, if so, how should it be governed and protected from interference by stakeholders?
• Finally, how should health care reform be paid for, particularly given the considerable upfront costs that will occur before pay-offs from improved quality and better prevention and wellness are realized?
2009 will be a landmark year in the debate over health care reform. Whether the outcome will look like 1994 or something completely different remains to be seen.
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 atracy@aasld.org