AMA comments on Senate health reform legislation

The AMA wrote a letter to Senate Majority Leader Harry Reid (D-Nev.) Dec. 1 concerning the Senate's proposed health system reform bill. The bill-in the form of a substitute amendment to H.R. 3590, the "Patient Protection and Affordable Care Act"-represents a melding of previous proposals reported by the Senate Committee on Health, Education, Labor, and Pensions and the Senate Finance Committee. In the letter (PDF), the AMA does not make a formal statement of support or opposition to the legislation in its current form. Given that Senate floor consideration is expected to last several weeks and the legislation will be amended, the AMA is reserving judgment on final passage of the Senate bill until later in the debate. The AMA letter focuses on aspects of the proposal that we support and are consistent with AMA policy, and those that we oppose with recommendations for improvements.

Provisions of H.R. 3590 that the AMA supports, include:

• Health insurance reforms to provide more choice and access to affordable coverage for individual and small businesses (e.g. pre-existing condition limitations, non-discrimination based on health status, annual and lifetime limits)
• Advanceable, refundable tax credits, inversely related to income to low-income individuals to purchase health insurance
• Creation of health insurance exchanges to stimulate competition and offer more affordable choices
• Additional federal funding to improve the Medicaid safety net
• Coverage for prevention and wellness initiatives without co-payments or deductibles
• Creation of an independent comparative effectiveness research entity to enhance patient-physician decisions on treatment options
• Administrative simplification provisions to streamline, standardize and lower the cost to process health insurance claims

The letter also includes a detailed discussion of provisions that the AMA opposes, which include:

• A one-year temporary patch to the Medicare physician payment formula instead of a permanent repeal of the sustainable growth rate
• Creation of an Independent Medicare Advisory Board empowered to mandate Medicare payment cuts to meet budgetary goals
• Development and application of a cost/quality index modifier to redistribute Medicare payments among providers based on outcomes, quality and risk adjustment measures that are not scientifically valid, verifiable and accurate
• Budget neutrality payment adjustment to partially offset bonus payments for primary care and general surgery specialties
• A 5 percent excise tax on elective cosmetic surgical and medical procedures
• Penalties for physicians who do not participate in the Physician Quality Reporting Initiative
• Restrictions on physician-hospital ownership
• Imposition of Medicare provider enrollment fees on physicians

The AMA remains committed to working with Congress and the Administration to enact comprehensive health system reform, and we will work vigorously to secure needed changes to H.R. 3590 as the legislation is amended on the Senate floor.

A summary (PDF) comparing H.R. 3590 to the bill passed by the House of Representatives, H.R. 3962, the "Affordable Health Care for America Act," and relevant AMA policy is available on the AMA Web site.