The New, New Healthcare Law

March 27, 2015

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Like the homeowner who winds up tripling his remodeling budget by telling the contractor “While you’re at it, can you …” Congress is wrapping up what might be the most significant healthcare bill since the Affordable Care Act of 2010.

What started out as a bill to fix a broken Medicare payment system for doctors has turned into a bit of a Christmas tree for pent-up healthcare policy changes. As the legislation made its way through the House – which passed it March 25, on a remarkable 392-37 bipartisan vote – it picked up several provisions. While some were related to the original intent of the bill, others fall into the “while you’re at it” category. Namely:

  • A two-year extension of the popular Children’s Health Insurance Program (CHIP). Funding was due to expire in September, and lawmakers at the federal and state levels wanted to extend it to keep 8 million low-income kids insured. Democrats wanted four more years but settled for two. Funding now will run through 2017.
  • An extension of funding for Community Health Centers, which serve 10 million poor and underserved patients in medically underserved communities.
  • An extension of funding for several diabetes research programs at the National Institutes of Health.

While the doctor lobby was happy about the end of the Sustainable Growth Rate (SGR) formula used to determine Medicare payments for physicians, they did have to agree to some limits on future fees. Medicare will raise its rates by 0.5 percent a year in 2015-19 and then freeze them until 2025. Individual doctors could do better if they score well on measures of the quality of their care.

The bill also addresses some of the issues around use of electronic health records (EHRs). It requires the Department of Health & Human Services to establish interoperability metrics by July 2016 and “widespread interoperability” by 2019. Hospitals and doctors will have to attest that they won’t block sharing of information from their patients or face fines.

Lawmakers also made some sensible changes in Medicare so that wealthier seniors will pay more of the cost of their coverage for outpatient care and prescription drugs. Increased “means testing” of these programs has been included in President Obama’s budget and backed by many Republicans. A special program to help low-income seniors pay their Medicare premiums was also made permanent.

A final Senate vote on the package is expected in mid-April after Senators return from Spring Break, but it will almost surely pass by a similar bipartisan margin.

In the same week Congress came together on this legislation, both houses voted along strict partisan lines to approve a nonbinding budget resolution that calls for repeal of the ACA and deep cuts in Medicare and Medicaid. None of that stands a chance of getting through Congress and a presidential veto.

So what does this sudden burst of bicameral, bipartisan cooperation mean? It is, most likely, a temporary cease fire in the healthcare wars to give legislators in both parties a chance to make progress on some of the less toxic issues while they continue to joust over the ACA. Advocates for sensible policies take heart!