AMERICAN ACADEMY OF EMERGENCY MEDICINE OPPOSES HOUSE HEALTH CARE REFORM BILL / U.S. Health Care Reform Could Leave Implementation to States

CAL/AAEM News Service somcaaem at hs.uci.edu
Mon Nov 23 11:32:28 PST 2009


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November 19, 2009
AMERICAN ACADEMY OF EMERGENCY MEDICINE OPPOSES HOUSE HEALTH CARE REFORM BILL

 The American Academy of Emergency Medicine<http://www.aaem.org/>

The American Academy of Emergency Medicine (AAEM) opposes the health care reform bill recently passed by the United States House of Representatives (HR 3962).  AAEM opposes this bill because of the failure of Congress to include any tort reforms.  Our tort system functions in such an aberrant and predatory manner that a large majority of lawsuits against physicians have no basis in fact.  Recent figures released from the Congressional Budget Office estimate a savings of at least $41 billion to government health programs through meaningful tort reforms.  However, when including the costly effects of defensive medical practices, other estimates project a savings of more than $200 billion per year through significant tort reforms.
Furthermore, the House version of the bill offers rewards to states that eliminate existing tort reforms.  Eliminating caps on non-economic damages and caps on attorney fees will exacerbate the liability crisis.  The United States has the world's only liability crisis because of the unique and highly atypical manner in which our tort system functions.  HR 3962 will worsen our liability crisis and the stresses it places on our society.  Therefore, AAEM urges the United States Senate to include significant tort reforms when it deliberates on the pending version of its health care reform bill.
HOUSE TO VOTE ON THE MEDICARE PHYSICIAN PAYMENT REFORM ACT, HR 3961
This week, a floor vote is planned in the House of Representatives on HR 3961, the Medicare Physician Payment Reform Act of 2009.  This legislation would permanently repeal the sustainable growth rate (SGR) formula that calls for annual cuts in Medicare physician payments, and replace it with a new, more rational payment system.  It would provide a Medicare Economic Index update for 2010 instead of a 21.2% cut.  And it would eliminate all SGR debt accumulated after years of these temporary fixes and establish new updates with two more generous spending targets.
Unless Congress acts, Medicare payments will be slashed by more than 21% in January, 2010 because of the SGR formula.  Without a permanent fix, many physicians may be forced to cut services to Medicare patients or stop seeing them altogether.
ACTION REQUIRED
Please urge your Representative to vote for passage of HR 3961.
Here's how:
    * Call 1-800-833-6354 to be connected to your Representative.
    * Urge him/her to vote "YES" when HR 3961 comes to the House floor for a vote.  Click here for talking points and additional information
- http://www.capwiz.com/aaem/callalert/index.tt?alertid=14351906
American Academy of Emergency Medicine
555 E. Wells Street
Suite 1100
Milwaukee, WI 53202-3823
800-884-2236
Fax: 414-276-3349
Website: www.aaem.org
November 2, 2009
U.S. Health Care Reform Could Leave Implementation to States

The California Healthline<http://www.californiahealthline.org/articles/2009/11/2/us-health-care-reform-could-leave-implementation-to-states.aspx>

If Congress succeeds in passing national health care reform legislation, much of the responsibility for implementing the changes could fall to states, the Washington Post<http://www.washingtonpost.com/wp-dyn/content/article/2009/10/31/AR2009103101769.html> reports.
Many of the reform proposals currently under debate would require state officials to make decisions about health benefits for low-income families, insurance company regulations and other matters.
Although the House's merged health care reform bill (HR 3962<http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3962:>) delegates substantial authority to the federal government, the bill still calls on states to help design a Medicaid expansion and develop high-risk insurance pools.
Under the Senate Finance Committee bill (S 1796<http://thomas.loc.gov/cgi-bin/query/z?c111:S.1796:>), states would need to make nearly every major decision about health reform implementation. The bill would allow each state to establish a health insurance exchange and determine which insurers can participate in the market.
In addition, the merged Senate bill likely would allow states to opt out of any federal public health insurance option.
Experts say a final health care reform bill is likely to more closely resemble the Senate's emphasis on state-based decision-making. Although the federal government will shoulder a large portion of national health reform costs, states likely will need to contribute a certain share and hire more administrators to carry out their new responsibilities.
Experts say that granting states greater decision-making authority could encourage them to adopt health system changes that meet the particular conditions of their region. This model also could allow officials to learn from each state's implementation experiences.
However, others caution that allowing each state to implement health reform could cause some states to fall behind in meeting minimum health system standards (Montgomery/Slevin, Washington Post, 11/1).
Penalties for Massachusetts?
In related news, Massachusetts officials are expressing concern that national health care reform legislation could damage the state's new health care program.
In 2006, Massachusetts passed a health care overhaul bill that aimed to provide health insurance to all state residents through state subsidies and other measures.
However, some current national health care reform proposals would offer federal subsidies that are significantly lower than Massachusetts' current subsidy levels.
Experts say that if Congress does not grant Massachusetts any exemptions, the state might need to decide whether to scale back its subsidies or increase its health care budget in order to close the subsidy gap (Wangsness, Boston Globe<http://www.boston.com/news/health/articles/2009/11/01/us_health_overhaul_could_penalize_mass/>, 11/1).
Is California a Model for Cost Control?
California's health care experiences provide "'proof of concept' that properly implemented health reform can control costs while improving the quality of medical care," Micah Weinberg, a senior research fellow in the California Program of the New America Foundation, argues in a Sacramento Bee<http://www.sacbee.com/opinion/story/2295481.html> opinion piece.
Weinberg writes that U.S. policymakers can learn from California's achievements by:
*      Addressing health care disparities and other environmental barriers to health care;
*      Fostering integrated health care systems such as Kaiser Permanente; and
*      Using health information technology to boost care coordination and reduce administrative inefficiencies (Weinberg, Sacramento Bee, 11/1).

Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine
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