Foundering Healthcare Reform Legislation, Torpedoed by Senate Election, Alarms Physician Advocates

January 20, 2010

January 20, 2010 — Medical societies that have advocated for healthcare reform face the possibility of coming up empty-handed now that the Massachusetts election of Republican Scott Brown to the US Senate has deprived Senate Democrats of a filibuster-proof, 60-vote bloc.

The consequences of no bill emerging from Congress, say leaders of organized medicine, would not be pretty — runaway costs, more and more uninsured, and fewer physicians choosing primary care due to inadequate reimbursement.

"The election in Massachusetts sends the message to lawmakers that the public isn't convinced the benefits of healthcare reform outweigh the costs," internist Joseph Stubbs, MD, president of the American College of Physicians, told Medscape Medical News. "But the College still believes reform is needed. Without it, our current course is unsustainable in terms of cost, and not having enough primary-care physicians."

Lori Heim, MD, president of the American Academy of Family Physicians, sounds the same alarms. "If reform doesn't pass, then once again, the American people will have lost a chance to gain healthcare security," said Dr. Heim.

Like Dr. Stubbs, Dr. Heim also emphasized the need to improve reimbursement for primary-care physicians to attract more clinicians to the field. A healthcare system tilted toward expensive subspecialist care, she said, "raises the question of whether we'll be able to control costs."

In an email to Medscape Medical News, the president of the American Medical Association, J. James Rohack, MD, stated that the Massachusetts Senate election "complicated the prospects for comprehensive health reform," but that the AMA would "stay engaged in the process to get the best outcomes for patients and physicians."

Dr. Rohack also noted in his AMA blog that some commentators argue that healthcare reform would raise taxes, destroy Medicare, and destroy jobs and yet "that is exactly what is happening with the status quo."

Why Reform Legislation Is Endangered

By defeating Democrat Martha Coakley, the Massachusetts attorney general, in Tuesday's election, Scott Brown gives Senate Republicans a critical mass of 41 votes and reduces the Democratic bloc to 59 (including 2 independents). Sixty votes are needed in the Senate to shut down a filibuster, which Republicans can employ to keep a bill from coming to the floor for a vote (filibustering is not allowed in the House).

The Republicans' ability to talk a bill to death dramatically alters the Democrats' legislative game plan, which revolves around separate reform bills passed by the House and Senate late last year. Before Brown's election, Democrats were attempting to modify the Senate bill with bits and pieces of House language and bring a single bill back to both chambers for a final vote. It is possible that could happen before Brown takes office, but some Democrats like Sen. Jim Webb (D-VA) are arguing that for the sake of good political sportsmanship, no vote should be held until Brown is seated.

By following that course, Democrats would run smack-dab into a Republican filibuster, which would include Brown, who campaigned against Democratic healthcare reform measures.

How Would the Senate Bill Fly in the House — and Organized Medicine?

Another way to enact reform in the no-bloc era is for the House to pass the Senate reform bill as is. That tactic eliminates the need for a Senate vote, but would House Democrats abandon their plan and obediently sign off on the Senate version?

Rep. Bart Stupak (D-MI), who voted for his chamber's reform legislation, told Fox News Wednesday that the Senate bill would not garner even 100 votes in the House unless it was extensively amended to accommodate House preferences.

The House bill, for example, takes greater pains to prevent federal premium subsidies from being used to pay for abortions, a provision authored by Rep. Stupak. He said House members also "are disappointed and disillusioned" by last-minute wheeling and dealing in the Senate, "especially when it looked like people were paid off for their vote."

For some sectors of organized medicine, House approval of the Senate bill, however unlikely that is, may be better than no bill at all.

"The Senate bill contains many provisions we support," said Dr. Heim. "We would support the fact that they've made a start on healthcare reform." Similarly, Dr. Stubbs said the ACP liked many aspects of the Senate bill, although he noted that it lacked important provisions found in the House version, such as increasing Medicaid reimbursement to physicians to Medicare levels.

While the Senate bill enjoyed the backing of AMA, it is anything but palatable to other medical societies. Last year, the American College of Surgeons and 19 other surgical groups took a stand against it, saying the legislation shortchanged specialists in favor of primary care colleagues, forced physicians to participate in Medicare's Physician Quality Reporting Initiative, and established a new Medicare commission with too much power over payment and coverage decisions.


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