Elsewhere on Capitol Hill: The Doc Fix and Antitrust Reform

As I discussed in great detail last week, both the Medicare reimbursement reforms for doctors (aka the “doc fix”) and the withdrawal of the Healthcare Insurance Industry’s support for healthcare reform sparked swift and reactive  responses from many on Capitol Hill.  The Hill quickly called for and moved forward on a plan to strip the insurance industry of their antitrust exemption.  While neither issue is more important than the other, they are certainly critical events because they involve constituencies who are needed for the longer term healthcare reform efforts. 

Let’s begin with the Medicare reimbursement reforms for physicians. In an increasingly rare show of bipartisan agreement, the Senate voted on Wednesday to block the repeal of the Medicare payment formula for physicians.  In a vote I believe represents a harbinger of things to come, Senate Republicans (40) and Democrats (13) simply could not bring themselves to vote in favor of a bill that will likely cost an additional $247 billion over 10 years on top of the other healthcare reform costs.  The cliff of a 21 percent decrease in Medicare physician payments looms over the discussions on healthcare reform like fog moving in on a clear day when the world gets shrouded and visibility lowered.  The problem is that despite bipartisan discussions on ways to offset the costs, no solution could be found.  In many respects, I was not surprised by the Senate’s action as the rhetoric and positioning on deficit spending has become louder and more pronounced over the last couple of weeks.  The “doc fix” became a referendum on deficit spending at a time when tensions among the various constituencies were high.   

The vote was of special importance since the American Medical Association, the largest association group of physicians within the United States, made it quite clear to Congress that their support of compressive healthcare reform hinged on fixing the Sustainable Growth Rate (SGR) problem in physician Medicare payments.  The lack of support for the reform bill was seen as a major test for Majority Leader Harry Reid and a big disappointment for the AMA.   Senator Reid introduced his “doc fix” bill earlier in the week in an effort to secure AMA support – which will now likely dissipate, if not disappear.  However, the Senate Majority Leader’s plan backfired badly when Senator Jon Kyl (R-AZ), a longtime supporter of SGR reform, suddenly reversed his support and voiced opposition to the proposed cut of the 10-year payment freeze.  Without the backing of Republicans and key Democrats, Reid is moving forward with a one-year fix similar to what has been done for the last decade.  In many respects, the Senate is putting off for tomorrow what it can’t resolve today. But, it is an issue that clearly needs resolution because without it, doctors will likely move to revolution. 

In addition – as I mentioned last week – Congressional Democrats began a push to strip the insurance industry of its anti-trust exemption. Created in 1945 by the McCarran-Ferguson Act, the anti-trust exemption allows states to regulate health insurance providers without federal intervention.  There are arguments on both sides of the equation with liberals arguing that it creates regional monopolies with inflated premiums while simultaneously discriminating against people based on their past health record.  Conservatives argue that the Act says little about healthcare and is not the center of the debate so why are we being diverted?

Regardless, on Wednesday, the House Judiciary Committee voted to strip the federal antitrust protection by a Committee vote of 20-9, including the support of three Republicans: Representatives Dan Lundgen (R-CA), Louie Gohmert (R-TX), and Tom Rooney (R-FL).  The vote came a week following the surprise report unveiled by the insurance industry arguing that healthcare reform would create the unintended consequence of increasing premiums.  Now, not everyone agrees with the action of the House.  In fact, Scott Harrington, a professor from The Wharton School at the University of Pennsylvania, made a compelling case in The Wall Street Journal on Wednesday that the anti-trust vote is a red herring.   But compelling or not, Senate Democrats also announced their intentions to support their House colleagues.  It is almost a certainty that the anti-trust exemption will be stripped before year’s end.  Leahy, who is the Chairman of the Senate Judiciary Committee, has already held a hearing into the matter and announced his intention to amend the Senate healthcare bill in order to add the exemption repeal. With Democrats working together to strip the healthcare insurers’ antitrust status, the industry is facing a long, dark winter.

Regardless of the anti-trust provision or not, I think we need to remember that making health insurance available to all citizens should remain our focus.  I’ve said it before and I’ll say it again – if I didn’t work for Perot Systems, I would not have health insurance, and it’s not because I couldn’t afford it.  No one would provide it to me because of pre-existing conditions.  My brother-in-law sent me a notice on the tragic situation facing Bill and Michelle Caudle and their family because she has a pre-existing healthcare problem – breast cancer – and, he is now without a job.  Let’s make sure that all of our leaders help us to keep our eye on the important stuff.

 Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.