Miscellaneous
Dates Set for the Supreme Court to Hear Challenge to the PPACA (January 2012)The U.S. Supreme Court announced that it will hear five-and-a-half hours of oral arguments in legal challenges to the Patient Protection and Affordable Care Act (PPACA, Pub. L. 111-148). The Court agreed to consolidate three cases and will address questions raised in Florida v. Department of Health and Human Services, National Federation of Independent Business v. Sebelius, and Department of Health and Human Services v. Florida. Oral arguments are scheduled to take place March 26 - 28.
The first hour of oral arguments will address whether the Anti-Injunction Act of 1867 (AIA) blocks a Commerce Clause challenge to the PPACAs individual mandate. The AIA precludes courts from considering a matter prior to the assessment or collection of a tax. The individual mandate requirements set forth under the PPACA do not take effect until 2014. Two hours of oral arguments are scheduled for March 27 to examine the constitutionality of the individual mandate. Finally, two-and-a-half hours of oral arguments are scheduled for March 28 to explore the severability of the individual mandate as well as the constitutionality of the Medicaid expansion contained in the PPACA. The oral arguments will consume the Courts entire schedule for the week. A ruling is expected as early as June. Individuals Selected for Innovation Advisors Program (January 2012)
CMS announced the selection of the first group of healthcare experts to participate in its Innovation Advisors Program. Participants are expected to test new models to improve care within federal healthcare programs. In all, CMS announced the selection of 73 individuals from 27 states and the District of Columbia to participate in the program. The advisors will work directly with the Center for Medicare and Medicaid Innovation (CMMI). The CMMI and funding for the program was created under the PPACA. In all, as many as 200 individuals will be selected to participate in the first year of the program. Participants organizations will receive a stipend of up to $20,000. For more information on the program, you can visit http://innovations.cms.gov/. Deficit Reduction Committee Fails to Reach Agreement (December 2011)
The Joint Select Committee on Deficit Reduction created under the Budget Control Act of 2011 (S. 365, Pub. L. 112-25) failed to reach agreement on how to reduce federal spending by $1.5 trillion over 10 years. The deadline to do so was November 23. Without congressional intervention, across-the-board reductions will begin on January 2, 2013. In announcing its inability to reach compromise the co-chairs of the committee stated, After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committees deadline. It is uncertain whether Congress will intervene to prevent the triggered cuts. Under the law, Medicare reductions are limited to two percent. Efforts Continue to Repeal the SGR (December 2011)
The House approved the Middle Class Tax Relief and Job Creation Act of 2011 (H.R. 3630) by a vote of 234 to 193 on December 13. In addition to proposals to extend the pay-roll tax cut and Unemployment Insurance (UI) programs, the legislation includes a provision to prevent the 27.4 percent reduction in physician reimbursement scheduled for January 1. H.R. 3630 replaces the scheduled reduction with a one percent increase for 2012 and 2013. The legislation also extends the Medicare Work Geographic Adjustment through 2012, among other things.
The Medicare physician reimbursement provisions of H.R. 3630 are estimated to cost approximately $38.9 billion over 10 years. H.R. 3630 would increase premiums for higher-income beneficiaries and decrease funding for the Prevention and Public Health Fund to pay for the increase in physician reimbursement for two years. The legislation also creates a cliff that will result in a 37 percent reduction in 2014 and increase the 10-year cost of repealing the Medicare Sustainable Growth Rate (SGR) formula to over $350 billion.
Senate leadership has indicated that it will not consider H.R. 3630 and the White House issued a statement of policy indicating that it will veto H.R. 3630 if it reaches the Presidents desk in its current form. It remains uncertain what package the Senate will consider and what legislation will ultimately clear both chambers. The ACOI is continuing to monitor this matter closely. Supreme Court Agrees to Hear ACA Challenge (December 2011)
The U.S. Supreme Court announced that it will hear legal challenges to the Patient Protection and Affordable Care Act (PPACA, Pub. L. 111-148). The Court agreed to hear legal questions presented in the case of Florida v. Department of Health and Human Services. The case was brought by the State of Florida and joined by 25 other states, the National Federation of Independent Business and two individuals. The U.S. Court of Appeals for the Eleventh Circuit in a 2-1 decision found the individual mandate to be unconstitutional on August 12.The majority found that the commerce clause of the Constitution does not allow the Federal government to mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time that they are born until the time that they die.
Oral arguments are expected to take place in March with a decision being handed down as early as June, 2012. Recognizing the gravity and complexity of the issues presented, the Supreme Court has allotted five-and-a-half hours for oral arguments. Generally, the Court allows just one hour for oral arguments per case. While cameras are not generally permitted in the Supreme Court during proceedings, several requests have been made asking the Court to allow television coverage of oral arguments in this matter. The Court has not provided an indication as to how it will respond to the request. Head of CMS Steps Down, New Nominee Announced (December 2011)
CMS Administrator Donald Berwick, MD, announced his departure from CMS effective December 2. Principle Deputy Administrator Marilyn Tavenner was announced as President Obamas nominee to fill the position. Ms. Tavenner served as Acting Administrator prior to Dr. Berwicks recess appointment in July, 2010. Prior to her time at CMS, Ms. Tavenner served as the Commonwealth of Virginias Secretary of Health and Human Resources. She holds a Bachelor of Science degree in nursing and a Masters in Health Administration. A confirmation hearing date has not been set. House Committee Approves Repeal of CLASS Program (December 2011)
The House Committee on Energy and Commerce reported out the Fiscal Responsibility and Retirement Security Act of 2011 (H.R. 1173) by a mostly party-line vote of 33 to 17 on November 30. H.R. 1173 would repeal the Community Living Assistance Services and Supports (CLASS) program established under the PPACA. The vote came on the heels of the Department of Health and Human Services announcing that the program was not financially sustainable. Republicans have said that repeal of the program is necessary to prevent the Administration from reviving the program in the future. Consideration of the legislation by the full House has not been scheduled. The CLASS program was the first federally-sponsored long- term care program available to working adults. Census Bureau Releases Data on Uninsured (November 2011)
According to data recently released by the U.S. Census Bureau, the number of people without health insurance coverage rose from 49.0 million in 2009 to 49.9 million in 2010. In addition, the Bureau reported that the number of people with health insurance increased from 255.3 million in 2009 to 256.2 million in 2010. During the same time, the percentage of people covered by private health insurance declined from 64.5 percent to 64 percent. The percentage of individuals covered by government health insurance increased from 30.6 percent to 31 percent. The Census Bureau data indicate that household income declined in 2010 and the poverty rate increased to 15.1 percent from 14.3 percent in 2009. For additional information on the recently released data you may visit www.census.gov. ACA Continues to Work its Way Through the Court System (November 2011)
The U.S. Court of Appeals for the Fourth Circuit recently issued two opinions that set back efforts to have the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148) ruled unconstitutional. In the case of Liberty University Inc. V. Geithner, the court declared it has no jurisdiction to hear the case as a result of the Tax Anti-Injunction Act (AIA). The AIA states that, No suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person. As such, the court said the AIA divests federal courts of subject-matter jurisdiction. The court went on to say that it was irrelevant that Congress labeled the mandate a penalty rather than a tax. The court suggested that had Congress intended to allow pre-enforcement challenges of the individual mandate, it could have amended the AIA through the ACA to allow such a challenge to go forward. The U.S. Court of Appeals for the Fourth Circuit was the first court to apply the AIA to challenges to the constitutionality of the ACA. In Virginia ex rel. Cuccinelli v. Sebelius, the court unanimously ruled the Commonwealth of Virginia did not have standing to challenge the constitutionality of the individual mandate. The court said that the mandate did not apply to the state and thus could not demonstrate that it would suffer an injury with the implementation of the mandate. This is a significant setback for the Commonwealth of Virginia case. As previously reported, there remains a split between the U.S. Court of Appeals for the Sixth Circuit and the U.S. Court of Appeals for the Eleventh Circuit. The Supreme Court is scheduled to discuss how it will handle challenges to the ACA in a closed-door conference on November 11. An announcement could be made as early as November 14. It appears likely that the Court will consider the constitutionality of multiple provisions of the ACA. HHS Implements Plan to Inventory and Streamline Regulations (November 2011)
In response to Executive Order No. 13563, HHS announced its Plan for Retrospective Review of Existing Rules to inventory and eliminate or streamline out-dated and overly burdensome regulations. The President issued the Executive Order in January directing federal agencies to create a more effective regulatory framework. The goals of HHS plan are to do the following: streamline or eliminate unjustified costs and burdens; increase transparency in the retrospective review process; increase opportunities for public participation; set clear retrospective review priority; and strengthen analysis of regulatory options. Supreme Court Likely to Review Constitutionality of ACA (August 2011)
The U.S. Court of Appeals for the Eleventh Circuit in a 2-1 decision found the individual mandate of the ACA to be unconstitutional on August 12. The court stopped short of declaring the entire law unconstitutional. The majority found that the commerce clause of the Constitution does not allow the Federal government to mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time that they are born until the time that they die. The case, Florida v. Department of Health and Human Services, was brought by 26 states and has been viewed as a likely candidate for the U.S. Supreme Court to consider the constitutionality of the ACA. As a result of the ruling, there is now a divide within the U.S. Court of Appeals. The U.S. Court of Appeals for the Sixth Circuit in a 2-1 decision upheld the constitutionality of the individual mandate in Thomas More Law Center v. Obama on June 29. As such, it is nearly certain that the U.S. Supreme Court will step in to resolve the split between the circuits. The U.S. Supreme Court is currently in recess and will begin its next term in October. Federal Government Avoids Default (August 2011)
The President signed into law the Budget Control Act of 2011 (S. 365, Pub. L. 112-25) on August 2, just hours before the government began to default on some of its financial obligations. The House approved the legislation on August 1 by a vote of 269 to 161. The Senate approved S. 365 on August 2 by a vote of 74 to 26. While the compromised legislation provided a temporary solution, it left many other problems on the table.
The legislation increased the debt limit by $900 billion, $400 billion of which is available immediately. Once the federal debt comes to within $100 billion of the debt ceiling the President may ask for an additional $1.2 trillion, which could rise to $1.5 trillion under certain circumstances. Central to the legislation is a Joint Select Committee on Deficit Reduction that is to propose at least $1.5 trillion in budgetary savings over 10 years. If the Committee fails to produce a recommendation that is approved by the House and Senate by December 23, a trigger will create automatic across-the-board reductions. S. 365 addresses educational funding as well. Specifically, the Act eliminates the interest subsidy on subsidized student loans for almost all graduate students while a barrower is in school, in the post-school grace period, and during any authorized deferment period beginning July 1, 2012. In addition, beginning July 1, 2012, the Act terminates the Secretary of Educations authority to make incentive payments to borrowers to encourage the on-time repayment of their federal loans. The current interest rate reduction will still be allowed for those who agree to repay their loans through electronic debiting.
The legislation does not include a mechanism to replace Medicares Sustainable Growth Rate (SGR) formula. In fact, if the Joint Commission fails to produce a package that is agreed to by both the House and Senate, physicians may face an additional two percent reduction on top of the 29.5 percent reduction projected for January 1, 2012. The ACOI will continue to closely monitor these negotiations. US Appeals Court Upholds Constitutionality of Affordable Care Act Provisions (July 2011)
The U.S. Court of Appeals for the Sixth Circuit upheld the constitutionality of the Affordable Care Acts individual mandate on June 29. In the case of Thomas More Law Center v. Obama, Thomas More Law Center argued that the ACA was not a valid exercise of Congress authority under the commerce clause of the Constitution. The argument has been made in many of the cases challenging the constitutionality of the ACA. The majority of the Sixth Circuit stated that the individual mandate, falls within Congress power to regulate activities that substantially affect interstate commerce. Judge Jeffrey S. Sutton, an appointee of George W. Bush, stated, Call this mandate what you willan affront to individual autonomy or an imperative of national healthcareit meets the requirement of regulating activities that substantially affect interstate commerce.
To date, this is the highest court to issue a decision in the cases challenging the constitutionality of the ACA. Two more appellate-level decisions are expected in the coming months. It appears that the cases will make their way before the Supreme Court during its 2011-2012 term with a decision being handed down by June 2012. National Prevention Strategy Released (July 2011)
The White House released the National Prevention and Health Promotion Strategy on June 16. The Strategy is intended to increase the overall health of all Americans. The Strategy was developed by the National Prevention Council, which consists of 17 federal agencies. According to a release by the Department of Health and Human Services the federal agencies consulted with both outside experts and stakeholders.
The Strategy, called for under the ACA, is intended to transform the healthcare delivery system away from a focus on sickness and disease to a focus on prevention and wellness. The following four strategic directions are laid out in the plan: building healthy and safe community environments; expanding quality preventive services in both clinical and community settings; empowering people to make healthy choices, and eliminating health disparities. Seven priority areas are as follow: tobacco free living; preventing drug abuse and excessive alcohol use; healthy eating; active living; injury and violence-free living; reproductive and sexual health, and mental and emotional wellbeing. You can learn more about the Strategy at www.healthcare.gov/center/councils/nphpphc/index.html. Senate Votes Down House Budget Resolution (June 2011)
The Senate rejected a motion to consider the House-approved budget resolution (H. Con. Res. 34) by a vote of 40-57 on May 25. As previously reported, the resolution establishes the budget framework for fiscal year 2012 and calls for about $6 trillion in spending cuts over the next decade, among other things. The vote was intended to place republicans on record as supportive of the resolutions provision to reform the Medicare program by creating a voucher program for future Medicare beneficiaries. Budget negotiations are ongoing and are expected to last through much of the year. House Approves 2012 Budget Resolution (May 2011)
The House approved H. Con. Res. 34 on April 15 by a vote of 235-193. The resolution establishes the budget framework for fiscal year 2012. The resolution calls for about $6 trillion in spending cuts over the next decade and would reduce the top income tax rate to 25 percent. The plan would also reduce domestic discretionary spending to levels below fiscal year 2008 levels. In addition, the budget resolution would reform the Medicare program by creating a voucher program for future Medicare beneficiaries. Budget negotiations are expected to last through much of the year. 2011 Appropriations Bill Signed into Law (May 2011)
The House and Senate avoided a shutdown of the federal government by approving the Full-Year Continuing Appropriations Act of 2011 (H.R. 1473, Pub. L. 112-10). After numerous continuing resolutions and returning from the brink of a shutdown, democrats and republicans agreed to a compromise package that funds the government through September 30, 2011. The Act provides $1.055 trillion for fiscal year 2011 and reduces spending by $39.9 billion over fiscal year 2010 levels. As part of the negotiations to approve H.R. 1473, the House and Senate agreed to consider legislation (H. Con. Res. 35) to block funding for the implementation of the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148). The Senate rejected the resolution by a vote of 47 to 53. The House approved the resolution by a vote of 240 the 185. H. Con. Res. 35 will not advance to the Presidents desk. Affordable Care Act Continues its Way through the Court System (May 2011)
The U.S. Supreme Court rejected a request by the Commonwealth of Virginia for expedited consideration of Commonwealth of VA v. Kathleen Sebelius on April 25. The U.S. District Court for the Eastern District of Virginia upheld the ACA but invalidated the requirement that individuals carry health insurance coverage. As a result, the U.S. Court of Appeals for the Fourth Circuit will now proceed to oral arguments. The Supreme Courts decision to deny an expedited review was not unexpected. The path to the Supreme Court for a challenge to the ACA continues to take shape. To date, both the Eastern District of Virginia and the U.S. District Court for the Northern District of Florida have found the individual mandate created by the ACA to be unconstitutional. Three other courts have upheld the constitutionality of the ACA. Appeals are currently pending in the U.S. Courts of Appeals for the 6th, 11th and the District of Columbia Circuits. ACOI Joins Partnership for Patients
The ACOI has joined the Partnership for Patients, which brings together hospitals, employers, physicians, nurses and patient advocates in a shared effort to improve patient safety and healthcare efficiency. The goals of the Partnership are to keep patients from getting injured or sick and to help patients heal without complication. The Partnership aims to decrease hospital-acquired conditions by 40% by the end of 2013. In addition, the Partnership intends to reduce hospital readmissions by 20% over the same time period. It has been estimated that achieving these goals will reduce healthcare costs by approximately $35 billion with a $10 billion savings to the Medicare program and additional savings over the next 10 years. You can learn more about the Partnership by visiting www.healthcare.gov. House Approves Legislation to Repeal Parts of the Affordable Care Act (May 2011)
The House continued efforts to repeal the ACA by approving H.R. 1213 and H.R. 1214 by votes of 238 183 and 235 191, respectively. H.R. 1213 would eliminate federal spending on grants to help states establish insurance exchanges. H.R. 1214 would eliminate mandatory funding for the construction of school-based health centers. The ACA provided $50 million a year for four years for the construction of the school-based health centers. While both H.R. 1213 and H.R. 1214 were approved by the House, it appears unlikely that they will be considered by the Senate. In fact, the White House has stated that H.R. 1213 would face a veto should it make it to the Presidents desk. Federal Courts Continue to Consider the Constitutionality of the Health Care Reform Act (March 2011)
The U.S. government has appealed the U.S. District Court for the Northern District of Floridas ruling in the case of State of Florida v. US Department of Health and Human Services. As previously reported, the court held the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148) is unconstitutional in its entirety. The appeal moves this case one step closer to the Supreme Court. In a separate decision, the U.S. District Court for the District of Columbia dismissed a lawsuit brought by individual plaintiffs who claimed the ACA individual mandate violated the Constitution. In the case of Mead v. Holder, the court ruled that the ACA was constitutional under the commerce clause of the Constitution. The judge found that the ACA regulates an activity that substantially affects interstate commerce. As such, the court ruled that the ACA does not violate the Constitution and Congress acted within its powers. Red Flag Rule Court Challenge Dropped (March 2011)
The D.C. Circuit Court declared an action brought by the American Bar Association (ABA) against the Federal Trade Commission (FTC) moot following enactment of the Red Flag Program Clarification Act of 2010 (Pub. L. 111-319). The suit challenged the FTCs definition of creditor and subsequent application to attorneys and physicians for purposes of the Red Flag rule. As earlier reported, the FTC interpreted creditor to include attorneys and physicians. Application of the rule to physicians would have resulted in a regulatory burden not intended or supported by legislative history. The ACOI and others challenged the FTCs application of the rule. This brings this matter to a successful conclusion. Continuing Resolution Keeps Government Open for Business (March 2011)
President Obama signed the latest continuing resolution (H.J. Res. 48) to fund the Federal Government into law on March 18. The continuing resolution includes $6.1 billion in cuts and runs until April 8. The funding bill was signed into law just hours before the government would have shut down. With the additional time, both the House and Senate must find common ground to fund government operations for the last six months of the 2011 fiscal year. H.J. Res. 48 was the fifth continuing resolution passed by Congress since October 2010. A government shutdown remains a possibility as Congress continues to negotiate the size of reductions in federal spending. Congress must also address the fiscal year 2012 budget. Form 1099 Reporting Requirement Repeal Clears the House (March 2011)
The House approved the Small Business Paperwork Mandate Elimination Act of 2011 (H.R. 4) on March 3 by a vote of 314 - 112. The Senate previously approved similar legislation. Under current law, businesses will be required to issue a Form 1099 for payment to corporations for goods or services that exceed $600 per year to each vendor beginning in 2012. The House and Senate versions of the legislation differ on how to offset the approximate $24.7 billion cost of repealing the Form 1099 reporting requirement. Both parties in the House and Senate have expressed a desire to repeal the requirement before it takes effect. It appears that a compromise will be found in the near-future. Federal Courts Continue to Consider the Constitutionality of Health Reform Act (February 2011)
Two recent decisions have held that all or part of the ACA is unconstitutional. Each decision moves this issue closer to consideration by the Supreme Court.
In the case of Commonwealth of Virginia v. Kathleen Sebelius, U.S. District Court Judge Henry E. Hudson stated that the Minimal Essential Coverage Provision exceeds the constitutional boundaries of congressional power. Specifically, the court struck down the provision that requires individuals to carry a minimum amount of health care insurance unless they qualify for one or more of the exceptions established in the ACA (the individual mandate). At issue is whether the Commerce Clause of the Constitution can be used to require an individual to purchase a minimum level of health insurance. Prior to the ruling issued by Hudson, other federal courts found the provision in question to be constitutionally sound. Importantly, Judge Hudson struck down only one provision of the ACA.
In the case of State of Florida v. US Department of Health and Human Services, Judge Roger Vinson also found the law to exceed Congress authority under the Commerce Clause. He went as far as to find that the individual mandate provision of the ACA is not severable from the law as a whole, and as such, he found the entire law to be unconstitutional. Judge Vinson went further than Judge Hudson and also ruled that the ACA could not be saved by applying the Necessary and Proper Clause of the Constitution. There are 26 states that are part of the Florida lawsuit. The ACA remains on track to go before the Supreme Court sometime before the 2012 elections. Berwick Renominated to Head CMS (February 2011)
President Obama renominated Donald Berwick to be Administrator of CMS. He was first nominated in April 2010 and was later named to the position in July 2010 as a recess appointment following a refusal by the minority to consider his nomination. Dr. Berwicks recess appointment will expire at the end of 2011. To date, a confirmation hearing has not been scheduled by the Senate Finance Committee. CMS has been without a permanent administrator since 2006. End-of-Life Planning Provision Removed from
Final Medicare Regulation (February 2011)
The White House announced that it will remove an end-of-life planning provision from the final rule entitled, Medicare Program; Payment Policies Under the Physician Fee Schedule and other Revisions to Part B for CY 2011. Specifically, the final rule contained language that provided for voluntary advance-care planning discussions between patients and physicians for Medicares new annual checkup created under the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148). The language in the final rule was similar to now-debunked claims of death panels in the healthcare reform debate. House Approves Legislation to Repeal Affordable Care Act (February 2011)
The House approved the Repealing the Job-Killing Health Care Act (H.R. 2) by a vote of 245-189 on January 19. The vote to completely repeal the ACA was along party lines with three Democrats voting for the bill. According to the non-partisan Congressional Budget Office (CBO), repeal of the ACA would increase the federal budget deficit by $145 billion from 2012 through 2019 and by $230 billion from 2012 through 2021. The Senate is not expected to consider H.R. 2.
Following approval of H.R. 2, the House approved a resolution (H.Res. 9) that instructed all committees with jurisdiction to consider alternatives to help lower healthcare premiums, protect the doctor-patient relationship, and give states more flexibility to run their Medicaid programs. In response to the adoption of the resolution, the House Judiciary Committee acted first and approved the Help Efficient, Accessible, Low-cost, Timely Healthcare Act (H.R. 5) by a vote of 18-15 on February 16. The legislation would create a $250,000 cap on non-economic damages, among other things. H.R. 5 is similar to the California medical liability reform model and legislation considered and approved by previous congresses. It appears unlikely that the Senate will consider H.R. 5 or similar legislation. Florida Challenge to Healthcare Reform Act Moves Forward (December 2010)
A federal judge in Florida refused to dismiss claims challenging the constitutionality of select provisions of the ACA on October 14. The suit under consideration by the court was brought by 20 states and the National Federation of Independent Business. Specifically, the senior US District Court Judge for the Northern District of Florida ruled that the case may go forward to examine the constitutionality of the individual mandate and the expansion of Medicaid created under the ACA. The judge did dismiss the states claims challenging the constitutionality of the employer mandate and the creation of state-based insurance exchanges finding that they did not create legitimate constitutional questions. This case is just one of several cases brought across the country challenging the constitutionality of the healthcare reform law. The American College of Osteopathic Internists continues to monitor this and other cases. Supreme Court Refuses to Hear California Challenge to Health Care Reform Act (December 2010)
The United States Supreme Court refused to hear a constitutional challenge brought in response to the ACA. Specifically, a former Republican state lawmaker from California asked the Court to consider his suit after a federal appeals court decided he did not have standing to challenge the constitutionality of the individual mandate established in the healthcare reform law. His case is still pending before the 9th Circuit Court of Appeals. It is common for the Supreme Court to refuse to hear cases that are still pending in lower courts. As previously noted, there are a number of cases working their way through the federal court system. The US Supreme Court will likely consider the constitutionality of certain provisions of the ACA within the next few years. To date, many of the legal arguments have asked whether Congress overreached the powers provided for in the Commerce Clause of the Constitution. Osteopathic Physician Elected to Congress (December 2010)
Osteopathic physician Joe Heck, D.O. became the first osteopathic physician elected to the United States House of Representatives since 1939. Dr. Heck is an emergency room physician in Henderson, Nevada. He will join 19 other physicians serving in the 112th Congress. There will be 17 physicians in the House and three physicians in the Senate. This represents the largest number of physicians ever to serve in Congress at one time. FDA Announces Changes to Cigarette Labels (December 2010)
The Food and Drug Administration (FDA) announced a new comprehensive tobacco control strategy on November 10. According to the FDA, the strategy is the most significant change to address tobacco use in over 25 years. Under the changes announced by the FDA, tobacco companies will be required to add color graphics and warnings to cigarette boxes and advertisements telling consumers that smoking can kill. Manufacturers that fail to include the color graphics will be prohibited from selling cigarettes in the United States by October 22, 2012. The new graphic photos and images will be required to cover 20% of all tobacco print ads and half the size of cigarette packs. Nine images will be chosen from 36 potential images released by the FDA. Cigarette makers will be required to rotate the nine final images. The final rule is expected out by late June, 2011. You may view the proposed images at www.fda.gov. Number of Uninsured Continues to Grow (October 2010)
According to data just released by the US Census Bureau in a report entitled, Income, Poverty, and Health Insurance Coverage in the United States, there were approximately 50.7 million people in the United States without healthcare coverage in 2009. This is an increase from the 2008 levels of 46.3 million. The Census Bureau reports that 2009 saw the largest number of uninsured individuals since the Bureau began keeping statistics in 1987. In addition, the total number of individuals with coverage fell from 255.1 million in 2008 to 253.6 million in 2009. This is the first time the total number of individuals with coverage decreased from year-to-year. The report noted that the percentage of people covered by private and employment-based coverage decreased. Coverage through government health insurance programs such as Medicare, Medicaid, the Childrens Health Insurance Program and military coverage increased for the third straight year. This report and other data is available at www.census.gov/. Patient-Centered Outcomes Research Institute Board Named (October 2010)
The U.S. Government Accountability Office (GAO) announced the members of the Patient-Centered Outcomes Research Institute Board (PCORI) on September 23. The PCORI was created by the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-148) to perform comparative effectiveness research. The board consists of 19 members representing the following constituencies: three represent patients or healthcare consumers; seven from the physician or medical provider community; three from private payers; three from pharmaceutical, device or diagnostic test companies; one quality improvement or health service researcher; and, two from federal or state governments. Eugene Washington, MD, MSc, Vice Chancellor, UCLA Health Sciences and Dean, Geffen School of Medicine, was named chair of the PCORI board of governors. Acting Head of Center for Medicare and Medicaid Innovation Named (October 2010)
The Centers for Medicare and Medicaid Services (CMS) announced that Richard Gilfillan, MD was named as the Acting Director of the Center for Medicare and Medicaid Innovation. The Center was created by the ACA to test payment and delivery system models to improve quality and control costs in public health insurance programs. Dr. Gilfillan was director of the performance-based payment policy staff at CMS at the time of his appointment. Prior to his roles at CMS, he served as president and chief executive officer of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System. It is not clear whether Dr. Gilfillans appointment will be made permanent. $320 Million in Grant to Expand Primary Care Workforce Announced (October 2010)
The Department of Health and Human Services (HHS) announced grants totaling $320 million to strengthen the healthcare workforce on September 27. The grants were made available through the ACA. Specifically, $253 million of the grant money will go to the following six health professions programs: $167.3 million for primary care and residency expansion; $30.1 million for the expansion of physician assistant training; $14.8 million for nurse managed health clinics; $5.6 million for state health workforce development; and, $4.2 million for personal and home care aide state training. The remaining $67 million will go toward Health Profession Opportunity Grants to provide low-income people with education, training and support services for jobs in healthcare. IRS Posts Healthcare Reform Rules for Employers (August 2010)
The Patient Protection and Affordable Care Act (PPACA)(Pub.L. 111-148) requires employers to report the value of the health insurance coverage they provide to employees on each employees annual W-2 Form beginning with the 2011 tax year. According to the Internal Revenue Service (IRS), the information is for informational purposes only so that employees are aware of the value of their healthcare benefits. The amount reported does not affect tax liability. Additional information is available at www.irs.gov House Energy and Commerce Committee Approves Healthcare Legislation Prior to Recess (August 2010)
Prior to the August recess, the House Committee on Energy and Commerce reported out multiple healthcare bills. The legislation considered by the Committee would help military veterans become emergency medical technicians; extend the protections provided by the Federal Tort Claims Act to licensed health providers who volunteer at community health centers; and, reauthorize the National All Schedules Prescription Electronic Reporting Act, among other things. The bills now await consideration by the full House. It remains uncertain when the House will consider this legislation. Case Challenging the Constitutionality of the Healthcare Reform Law May Go Forward (August 2010)
As reported earlier, there will be a number of lawsuits challenging provisions of the Patient Protection and Affordable Care Act (PPACA)(Pub.L. 111-148). One of the first suits, brought by the Attorney General of the Commonwealth of Virginia, has been permitted to go forward. A federal district court judge refused to dismiss the lawsuit challenging the constitutionality of the healthcare reform law.
The judge for the U.S. District Court for the Eastern District of Virginia found that the Virginia had sufficiently demonstrated standing to challenge the law. Specifically, Virginia is challenging the constitutionality of requiring individuals to buy insurance. In allowing the case to go forward the judge stated, While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate and tax a citizens decision not to participate in interstate commerce. Neither the U.S. Supreme Court nor any circuit court of appeals has squarely addressed this issue. The ACOI will continue to closely monitor this and other cases that arise out of enactment of the PPACA. IRS Announces Tax Incentive for Those Who Work in Underserved Areas (July 2010)
The Internal Revenue Service (IRS) announced efforts to strengthen the healthcare workforce in underserved areas on June 16. The IRS announced that, “Under the Affordable Care Act healthcare professionals who received student loan relief under state programs that reward those who work in underserved communities may qualify for refunds on their 2009 federal income returns as well as an annual tax cut going forward.” Prior to the enactment of the “Patient Protection and Affordable Care Act,” only amounts received under the National Health Service Corps Loan Repayment and Forgiveness Program were eligible for the tax benefit. As a result of this legislation, the tax exclusion applies to any state loan repayment or loan forgiveness programs intended to increase the availability of healthcare services in underserved or health professional shortage areas. Additional information is available from the IRS at www.irs.gov/newsroom/article/0,,id=224387,00.html . Prevention and Public Health Council Created by Executive Order (July 2010)
The President created the National Prevention, Health Promotion and Public Health Council by Executive Order on June 10. The Council, comprised of Cabinet members and other top officials, is charged with developing and making public a national prevention, health promotion and public health strategy that is to be reviewed annually. The Surgeon General serves as the Chair of the Council which is housed within the Department of Health and Human Services. Patient Bill of Rights Released (July 2010)
Interim final rules implementing certain consumer protections contained in the “Patient Protection and Affordable Care Act” were issued on June 22. The rules are effective August 27. Under the new “Patient Bill of Rights” insurance companies are prohibited from imposing pre-existing condition exclusions on children, prevention policy rescissions for unintentional mistakes on an application for insurance coverage, may not set lifetime limits on coverage and the use of annual limits on coverage, is restricted, among other things. You may view a fact sheet on the “Patient Bill of Rights” at www.whitehouse.gov/sites/default/files/Consumer%20reg%20Fact%20Sheet.pdf. FTC “Red Flag” Rule Delayed (July 2010)
The Federal Trade Commission (FTC) announced that it was delaying, for the fifth time, enforcement of the “Red Flag” rules from June 1, 2010 to December 31, 2010. The delay preceded an agreement by the FTC to temporarily exempt physicians from application of the “Red Flag” rules until the U.S. Court of Appeals for the District of Columbia settles questions over the scope of the Commission’s rule. Under the rules, financial institutions and creditors must put in place identity theft prevention programs to identify, detect and respond to specific activities that could indicate identity theft. The ACOI and others have challenged the FTC’s interpretation that physician’s fall under the definition of “creditors.” Additional information will be provided in upcoming newsletters. President Appoints Head of CMS (July 2010)
President Obama appointed Donald Berwick, MD, as Administrator of the Centers for Medicare and Medicaid Services on July 7. Dr. Berwick was previously nominated on April 7 for the position. Dr. Berwick is a pediatrician by training and was most recently the president and CEO of the Institute for Healthcare Improvement. He was also a professor at Harvard Medical School and the Harvard School of Public Health. A recess appointment is used from time-to-time to place an individual into a position in a more expeditious fashion. The appointment expires at the end of the Congressional session, which will be the end of calendar year 2011. President Obama re-nominated Dr. Berwick for confirmation by the Senate on July 19. Dr. Berwick will be responsible for overseeing much of the implementation of the “Patient Protection and Affordable Care Act” (PPACA, Pub.L. 111-148). Dr. Berwick is a recognized expert in health system reform. The Congressional Budget Office (June 2010)
(CBO), which is the non-partisan body that estimates the cost of legislation for Congress, has said that the PPACA will reduce the federal deficit by $138 billion from 2010 through 2019. While there are competing estimates, the actual costs of the PPACA will become clearer as the healthcare reform law is implemented over the next few years. New Analysis on Healthcare Reform Costs Released (June 2010)
According to a report released by the Centers for Medicare and Medicaid Services’ Chief Actuary, Richard S. Foster, the PPACA will increase total national healthcare spending by $311 billion over the next 10 years. The increase is in part the result of providing coverage to over 34 million Americans who now lack coverage. The analysis does not take into consideration provisions of the PPACA that increase revenues. The United States now spends about $2.5 trillion on healthcare annually. Harvard Professor Nominated to Head CMS(June 2010)
President Obama nominated Donald Berwick, MD as Administrator of the Centers for Medicare and Medicaid Services. Dr. Berwick is a pediatrician by training and is currently the president and CEO of the Institute for Healthcare Improvement. He is a professor at Harvard Medical School and the Harvard School of Public Health. According to a statement released by President Obama, “Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower costs.” The Senate Finance Committee will be responsible for Dr. Berwick’s confirmation hearing. To date, a hearing has not been scheduled. New Healthcare Reform Law Materials Available to ACOI Members (June 2010)
The signing into law of the “Patient Protection and Affordable Care Act” (PPACA)(H.R. 3590)(Pub.L. 111-148) ushered in fundamental changes to the healthcare delivery system. In an effort to keep you abreast of changes that impact the practice of medicine, the ACOI has created an online resource that contains information related to the implementation of the PPACA. The resources are available at www.acoi.org under the “Government Affairs” tab. The resource will be updated as regulations are promulgated to implement the Act. Any questions or comments should be directed to Tim McNichol at the address above. Health Care Reform Legislation Signed into Law (April 2010)
History was made when President Obama signed into law the “Patient Protection and Affordable Care Act” (PPACA)(H.R. 3590)(Pub.L. 111-148) on March 23. The signing of the PPACA into law was the culmination of over a year of debate and political wrangling. H.R. 3590 was first introduced in the House as the “Service Members Home Ownership Tax Act of 2009” on September 17, 2009. It was approved under suspension of the rules by a vote of 416-0 and sent to the Senate for consideration. The Senate amended the bill stripping the original legislative language and inserted the text of the “Patient Protection and Affordable Care Act.” In a rare Christmas Eve vote, the Senate approved H.R. 3590 as amended by a vote of 60-39. The House agreed to the Senate amendments by a vote of 219-212 on March 21. The legislation was approved in both chambers along party-lines. As part of the negotiations to attain the needed votes in the House to approve the Senate-passed H.R. 3590, the House moved and approved a “corrections” package to further amend the health care reform package once it was signed into law. The corrections package, entitled the “Healthcare and Education Reconciliation Act of 2010” (H.R. 4872), was signed into law on March 30. The non-partisan Congressional Budget Office estimates the PPACA and H.R. 4872 will cost $938 billion over ten years. Further, the CBO estimates that the combined bills will reduce the federal deficit by $118 billion over the same time period. Click here for a summary of the key provisions of the PPAC as amended. Additional information will be made available at www.acoi.org as regulations are advanced to implement the legislation. State of the Union Speech Calls for Continued Healthcare Reform Efforts
(February 2010)
President Obama delivered his first official State of the Union speech before a joint session of Congress on January 27. While a large part of his speech addressed various components of the economy and efforts to create jobs, he did address the current state of the healthcare reform debate in Washington. The President addressed the stalled negotiations and asked Congress to “take another look” at the proposals that have been advanced. He reiterated his belief that legislation is still needed and reaffirmed his position that individuals and families with existing insurance should be able to maintain their current coverage and still see their physician if they choose to do so. With respect to the troubled healthcare reform talks, the President concluded by saying, “If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know…I am eager to see it.” It remains to be seen whether a compromise can be reached. The one thing that is almost certain is that it is highly unlikely that Congress will be able to send to the President’s desk a package as broad as those earlier approved by the House and Senate by narrow margins. Televised Healthcare Reform Talks Scheduled (February 2010)
In an effort to advance healthcare reform legislation, President Obama scheduled a televised bi-partisan healthcare reform summit on February 25. The Administration said it is hosting the meeting in an effort to move forward on comprehensive healthcare reform legislation. Critics have expressed concern that the meeting will be void of any meaningful effort to find true compromise. President Obama is looking to modify the proposals that have been advanced to date in an effort to sign legislation into law before the end of the year. The election of Senator Scott Brown and the approaching mid-year elections are certain to complicate these efforts. The political tenor of the debate suggests that it is going to be difficult to find a common ground from which to work that would appeal to conservatives, liberals, moderates and others on both sides of the aisle. Massachusetts Special Election Changes Healthcare Reform Debate
(February 2010)
Republican Scott P. Brown’s election to fill the US Senate seat vacated by Senator Edward M. Kennedy on January 19 changed the landscape of the healthcare reform debate, as well as the prospects for any legislation that is viewed to be controversial. As a result of Senator Brown’s election, the Senate consists of 59 Democrats and 41 Republicans. Sixty votes are needed to end filibusters, which have become increasingly common. The change in the composition of the chamber will allow the minority to indefinitely delay floor action on any matter before the Senate. In the end, Senator Brown’s election has called into doubt the enactment of a comprehensive healthcare reform package. The majority leadership in the House and Senate are left trying to find a way to move forward. It appears unlikely that a comprehensive healthcare reform bill will be sent to the President’s desk without considerable modification of the packages that have been advanced thus far. Human Embryonic Stem Cell Lines Approved by the NIH (January 2010)
The National Institutes of Health (NIH) announced the approval of the first 13 human embryonic stem cell lines for use in federally-funded research on December 2. The final guidelines establishing the policy and procedures for federal funding of embryonic stem cell research was published on July 7 in the Federal Register and was in response to Executive Order (EO) 13505 entitled, “Removing Barriers to Responsible Scientific Research Involving Human Stem Cells.” The EO removed an existing ban on federally-funded stem cell research put in place by the previous administration. According to a press release issued by the NIH, 11 of the approved lines were developed at the Children’s Hospital Boston and two approved lines were developed at Rockefeller University in New York City. Additional embryonic stem cell lines are under review. Funds Announced to Improve Community Health Centers (January 2010)
President Obama announced that $600 million in stimulus funds are being made available to fund Community Health Centers. According to the announcement, the funding will support health center construction, the adoption of health information technology systems and fund a medical home demonstration project to evaluate the benefits of the patient-centered medical home. In announcing the funding, President Obama said, “Taken together, these three initiatives…won’t just save money over the long term and create more jobs, they’re also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it.” Health Care Reform Package Approved by the Senate (January 2010)
After 25 consecutive days of being in session, the Senate approved the “Patient Protection and Affordable Care Act” (H.R. 3590) with amendment on December 24 by a vote of 60 – 39. The last time that the Senate conducted a roll call vote on Christmas Eve was 1895. Approval of H.R. 3590 in the Senate follows the House’s adoption of the “Affordable Health Care for America Act” (H.R. 3962) approved on November 7 by a vote of 220 – 215. The two chambers must work to merge the different provisions of H.R. 3962 and H.R. 3590 into one conference report that can garner enough votes to pass both the House and Senate. Many barriers remain in the effort to produce a final bill that can obtain the support needed to send a package to the President’s desk for his signature. The issues of abortion and how to pay for the legislation remain key sticking points. Negotiations are ongoing. The status of the health care reform debate in the Senate continues to change. For the most current news and information you may sign up for the ACOI government affairs listserv at www.acoi.org/InteractListerve.html. In addition, if you have any questions or concerns you may contact Tim McNichol directly at tmcnichol@acoi.org or by calling 1-800-327-5183. Senate and House Continue Work on Health Reform Legislation (November 2009)
House and Senate leadership continue to confront the daunting task of melding together legislative language approved by five separate congressional committees. Compounding difficulties created by partisan differences are internal divides within the majority party over such issues as abortion, cost and healthcare coverage for illegal aliens. The House took a significant step forward with the approval of the �Affordable Health Care for America Act� (H.R. 3962) on November 7 by a vote of 220-215. The measure was approved along mostly party lines with one republican voting for the bill and 39 democrats voting against the legislation. The bill encompasses most of the amendments made to the �America�s Affordable Health Choices Act� (H.R. 3200) when considered by the House Ways and Means, Energy and Commerce and Education and Labor Committees. H.R. 3962 contains many of the provisions found in H.R. 3200 with the omission of language to address the Medicare Sustainable Growth Rate (SGR) formula. This language was introduced as stand-alone legislation entitled the �Medicare Physician Payment Reform Act� (H.R. 3961). H.R. 3961 is scheduled to be considered by the House during the week of November 16. Prior to passage of H.R. 3962, the House considered and adopted an amendment offered by Representatives Bart Stupak (D-MI) and Joseph Pitts (R-PA) by a vote of 240-194 with one member voting present. The amendment prohibits the use of federal funds for abortions except in instances where the mother�s health is at risk, or in cases of rape or incest. Adoption of the amendment was crucial in garnering enough votes to secure the passage of H.R. 3962. In the Senate, Majority Leader Harry Reid (D-NV) continues to work to produce a legislative package that encompasses many of the provisions approved by the Senate Finance and Health, Education, Labor and Pensions (HELP) Committees. As this is written, legislation has not been introduced for consideration by the full Senate. Additional inter-party complications have emerged following the adoption of the Stupak-Pitts amendment in the House, calls by the Whitehouse to act quickly, and statements by the Majority Leader indicating that he will not allow the process to be rushed. Many obstacles remain in both the House and Senate before a final package can be sent to the President for his signature. In an effort to keep the ACOI membership informed about policy positions taken by the ACOI, all correspondence sent to Congress and regulatory bodies may be viewed at www.acoi.org. We also provide a government affairs listserv where you can receive current healthcare policy news and updates as well as engage in dialogue with your peers. You may sign up for this listserv and others at www.acoi.org/InteractListserve.html. In addition, if you have any questions or concerns you may contact Tim McNichol directly at or by calling 1-800-327-5183. Senate Confirms Surgeon General (November 2009)
The Senate confirmed Dr. Regina Benjamin as Surgeon General on October 29. Dr. Benjamin became the 18th Surgeon General by a unanimous voice vote. She is only the third woman to hold the post. As surgeon general, Dr. Benjamin serves as America�s chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury. House Committee Approves Legislation to Partially Repeal Antitrust Exemption (November 2009)
The House Judiciary Committee approved the �Health Insurance Industry Antitrust Enforcement Act of 2009� (H.R. 3596) on October 21. The legislation would partially repeal the antitrust exemption that applies to health and medical malpractice insurers as a result of the 1945 McCarran-Fergunson Act. H.R. 3596 is intended to prevent health and medical malpractice insurers from engaging in price fixing, bid rigging, or market allocations that would adversely impact competition and consumers. While H.R. 3596 has not been scheduled for consideration by the full House, its text is included in section 262 of the �Affordable Health Care for America Act� (H.R. 3962). Ryan White Care Act Signed into Law (November 2009)
The President signed the �Ryan White HIV/AIDS Treatment Extension Act of 2009� into law on Oct. 30. The Act extends the Ryan White HIV/AIDS program through fiscal year 2013. Specifically, the Act authorizes $2.35 billion to fund medication, health care and support services in fiscal year 2010 with increases through fiscal year 2013 to an annual authorization level of $2.7 billion. The Act also removes the �sunset� provision that would have repealed the law on a set date. �Red Flag� Rules Implementation Deadline Extended (November 2009)
The Federal Trade Commission (FTC) announced that it was delaying, for the fourth time, enforcement of the �Red Flag� rules from Nov. 1, 2009 to June 1, 2010. The delay comes in response to a request by House members. Prior to the announcement, the House approved H.R. 3763 by a vote of 400-0 to exclude certain small businesses from the �Red Flag� rules requirements and to require the FTC to issue new rules that allow an entity to apply for an exemption. H.R. 3763 would exclude healthcare, accounting and legal practices with 20 or fewer employees from the creditor category. Healthcare Reform Efforts Continue in Washington (August 2009)
The healthcare reform debate continues as Congress returns home for the August recess. Legislators in both the House and Senate, on both sides of the aisle, are continuing efforts to expand access to care, increase the number of physicians, and restructure the health care delivery system to meet these goals. The ultimate success of healthcare reform efforts will rely on Congress� ability to promote greater efficiency and increased quality. To date, four of the five congressional committees with jurisdiction have approved healthcare reform legislation, with only the Senate Finance Committee failing to do so. Most recently, the House Committee on Energy and Commerce approved the �America�s Affordable Health Choices Act of 2009� (H.R. 3200) along party lines by a vote of 31 to 28. It is expected that the full House will vote on healthcare legislation as early as September when Congress returns from the August recess. The August recess will be used to merge the legislation approved in the House Committees on Energy and Commerce, Ways and Means and Education and Labor. Humayun Chaudhry, DO, MS, ACOI President, recently sent a letter to Speaker of the House Nancy Pelosi in response to ongoing efforts to advance the �America�s Affordable Health Choices Act of 2009� (H.R. 3200). In his letter he emphasized the need to protect the patient-physician relationship and ensure that patients continue to have a choice with regard to where they obtain their health coverage. In addition, the letter discussed the importance of expanding the availability and reducing the cost of graduate medical education. Finally, it stressed the importance of reforming the current Medicare physician payment formula and the financial savings that could be realized by including provisions to reform the medical liability system. Understanding that any legislation signed into law to reform the health care delivery system will change the future of medicine, the ACOI commented on areas that would promote an increase in the number of physicians, protect the patient-physician relationship, and encourage the ability of patients to maintain control over their health care. You may view Dr. Chaudhry�s letter discussing health care reform and H.R. 3200 at
The Federal Trade Commission (FTC) announced that it will again delay enforcement of its �Red Flags� rule on July 29. According to a statement released by the FTC, �To assist small businesses and other entities, the Federal Trade Commission staff will redouble its efforts to educate them about�what must be done to comply.� The rules, which were set to go into effect on May 1, will now become effective November 1. Under the rules, financial institutions and creditors must put in place identity theft prevention programs to identify, detect and respond to specific activities that could indicate identity theft. As previously noted, the ACOI and others have challenged the FTC�s interpretation that physicians fall under the definition of �creditors.� You can find more information about the rule and how to comply by visiting the FTC�s Red Flags rule web site at www.ftc.gov/redflagsrule. Alabama Physician Nominated for Surgeon General (August 2009)
President Obama named Dr. Regina Benjamin as his nominee for U.S. Surgeon General on July 20. Dr. Benjamin, a family physician, led Alabama�s state medical society and has dedicated her career to healthcare for poor and rural populations. She studied medicine at the University of Alabama before going into solo practice. She converted her practice into a clinic to serve a small shrimping town. The clinic was devastated by Hurricane Katrina in 2005 but quickly reopened to provide needed healthcare services. The Senate HELP Committee will consider Dr. Benjamin�s nomination prior to action by the full Senate. To date, a hearing has not been scheduled. Geneticist Nominated to Head the National Institutes of Health (August 2009)
President Obama nominated Dr. Francis S. Collins to lead the National Institutes of Health on July 9. Dr. Collins is a renowned geneticist who was head of the National Human Genome Research Institute from 1993 until 2008. He was an integral part of efforts to map the human genome. In 2007 he was awarded the Presidential Medal of Freedom for his research. The Senate HELP Committee approved Dr. Collins� nomination by voice vote without a formal hearing. He served under both the Clinton and George W. Bush administrations and is expected to be easily confirmed by the full Senate. The NIH performs or funds over $30 billion in annual healthcare research. CDC Announces Environmental Health Tracking Service (August 2009)
The Centers for Disease Control and Prevention (CDC) announced a new environmental health tracking service on July 7. The service called the Environmental Public Health Tracking Network, pinpoints information such as rates of asthma, childhood lead poisoning, low birth weights and other data. While all 50 states are expected to participate in the program, there are only 16 states and the City of New York in the data base at this time. You may obtain more information by visiting www.cdc.gov. Is Your National Provider Identifier Information Up to Date? (August 2009)
The National Plan and Provider Enumeration System (NPPES) has issued nearly three million National Provider Identifiers (NPIs) since 2005. More than 700,000 NPIs have been assigned to physicians. Certain information in the NPPES is made available to the public. As such, it is essential to keep your information up to date. Medicare regulations require that any changes be reported within 30 days. The Centers for Medicare and Medicaid Services is encouraging all physicians to review their data and up date it where necessary. If you have not already established an NPPES user id and password you may obtain assistance by contacting the NPI Enumerator at 1-800-465-3203. Food and Drug Administrator Confirmed by the Senate (June 2009)
Dr. Margaret Hamburg was confirmed as the Commissioner of the Food and Drug Administration by the Senate on May 18. Dr. Hamburg, a bioterrorism expert, was confirmed by the Senate by voice vote. Prior to her selection and confirmation as the FDA Commissioner, Dr. Hamburg served as the Commissioner of Health for New York City and as the assistant director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Dr. Hamburg is a graduate of Harvard Medical School and is an internist. She will now oversee the FDA which is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nation�s food supply, cosmetics, and products that emit radiation. President Appoints Director of the Centers for Disease Control and Prevention
(June 2009)
President Obama appointed Dr. Thomas Frieden as Director of the Centers for Disease Control and Prevention on May 15. Dr. Frieden was serving as the commissioner of the New York City Health Department at the time of his appointment as Director of the CDC. While commissioner of health, Dr. Frieden worked to increase cancer screening, reduce the number of smokers and responded to cases involving anthrax, plague, and H1N1 influenza. According to a statement released by the White House, �Dr. Frieden is an expert in preparedness and response to health emergencies, and has been at the forefront of the fight against heart disease, cancer, obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records.� Dr. Frieden is expected to begin at the CDC early this month. Implementation of the �Red Flag� Rules Delayed�Again (June 2009)
The Federal Trade Commission (FTC) announced a last-minute delay of the implementation of its �Red Flag� rules on April 30. The rules, which were set to go into effect on May 1, will now become effective August 1. Under the rules, financial institutions and creditors must put in place identity theft prevention programs to identify, detect and respond to specific activities that could indicate identity theft. The ACOI and others have challenged the FTC�s interpretation that physicians fall under the definition of �creditors.� You can learn more about the �Red Flag� rules at http://www.ftc.gov/redflagsrule. FDA Regulation of Tobacco Products Legislation Advances (April 2009)
The House of Representatives approved the �Family Smoking Prevention and Tobacco Control Act� (H.R. 1256) on April 2. H.R. 1256 would give the Food and Drug Administration (FDA) the power to regulate tobacco products. Specifically, the legislation would allow the FDA to: regulate tobacco advertising and marketing; require larger warnings on cigarette packs; and, regulate nicotine levels, among other things. The House approved the legislation by a vote of 298-112. H.R. 1256 has been placed on the Senate legislative calendar where it awaits action by committees of jurisdiction and the full Senate. To date, additional consideration has not been scheduled. Governor Nominated to Head Department of Health and Human Services (April 2009)
President Obama announced the nomination of Democratic Kansas Governor Kathleen Sebelius as Secretary of Health and Human Services (HHS) on March 2. Governor Sebelius, if confirmed by the Senate, will oversee HHS and its nearly $80 billion in discretionary spending and hundreds of billions in entitlement programs such as Medicare and Medicaid. In addition, Governor Sebelius will be an intricate part in the Administration�s efforts to reform the health care delivery system. Prior to serving as Governor, Kathleen Sebelius worked as Kansas� insurance commissioner for eight years. Governor Sebelius� nomination follows the failed nomination of former Senate Majority Leader Tom Daschle.
The President also announced that Nancy-Ann DeParle will serve as Counselor to the President and Director of the White House Office for Health Reform. DeParle served as commissioner of the Tennessee Department of Health and Human Services and served in the Clinton administration as administrator for the Centers for Medicare and Medicaid Services (CMS). She also worked in the Office of Management and Budget.
President Releases 2010 Budget Proposal (April 2009)President Obama released his $3.55 trillion budget proposal for fiscal year 2010 on February 26. Included in the budget is $76.8 billion for the Department of Health and Human Services (HHS). The budget proposal also includes an additional $329 billion for Medicare physician payments over 10 years. While the proposal does not set forth a specific mechanism to reform the physician payment formula, the President expressed support for a �fiscally responsible� payment fix and assumed for budget purposes that Congress would not allow the projected cuts to take place. The Administration proposed a $630 billion health care reform reserve fund funded by increased revenue and savings obtained by proposals to increase efficiency, accountability and quality. In addition, the proposed budget includes over $6 billion to begin doubling cancer research funding at the NIH. Finally, the budget proposal provides $330 million to address the health care providers shortage by expanding loan repayment programs for physicians and others who agree to practice in medically underserved areas. You may learn more about the 2010 budget proposal by visiting www.whitehouse.gov/omb/. Economic Stimulus Legislation Signed into Law (April 2009)
President Obama signed the �American Recovery and Reinvestment Act of 2009� (ARRA)(Pub. L. 111-5) into law on February 17. The House and Senate approved the Act by a vote of 246-183 and 60-38, respectively. The ARRA will spend approximately $787.2 billion dollars in an effort to stimulate the receding economy. In addition to approximately $300 billion in tax cuts, the Act provides for increased government spending in areas such as infrastructure, extended unemployment benefits and efforts to expand the availability of renewable energy. Also included in the ARRA are provisions that promote reform of the health care delivery system by reducing medical errors, increasing efficiency and improving access to health care services. The Act provides for, among other things, the following in support of these goals:
- $19 billion in Medicare and Medicaid incentive payments for the adoption of certified electronic health records from 2011 through 2015
- Establishment in statute the Office of the National Coordinator for Health Information Technology (ONCHIT)
- Expansion of Health Insurance Portability and Accountability Act (HIPAA) patient privacy protections
- Creation of health information technology (HIT) policy and standards committees
- $87 billion in additional Medicaid funding
- $1 billion for prevention and wellness programs
- $10 billion for the National Institutes of Health (NIH)
- $500 million for primary care training programs through Titles VII and VIII and through the National Health Service Corps
- $1.1 billion to conduct comparative effectiveness research
- Establishment of a federal coordinating council for comparative effectiveness
In an effort to increase transparency, the White House has established a website to allow individuals to track the distribution of funds under the ARRA. You may access the website at www.recovery.gov. Should you have any question regarding the ARRA, you may contact Tim McNichol at tmcnichol@acoi.org or by calling toll-free 1-800-327-5183.
SCHIP Reauthorization Signed into Law (February 2009)The President signed into law the �Children�s Health Insurance Program Reauthorization Act of 2009� (H.R. 2) (Pub. Law 111-3) on February 4. The legislation reauthorizes the State Children�s Health Insurance Program (SCHIP) for four-and-a-half years. The law is expected to maintain coverage for 6.7 million children and expand coverage to an additional 4.1 million low-income children. The legislation provides an additional $32.8 billion in funding paid for by an expansion of the federal cigarette tax. The Act extends coverage to legal immigrant children and to pregnant woman who have been in the country fewer than five years. Strenuous objections were raised over the language expanding SCHIP eligibility guidelines. Final passage in both chambers occurred largely along party lines. Similar legislation was vetoed twice by President Bush in the prior Congress. Obama Administration Continues Search For Secretary of Health and Human Services (February 2009)
It was presumed by many that the nomination of former Senate Majority Leader Tom Daschle would culminate in the rapid confirmation of the next Secretary of the Department of Health and Human Services. Mr. Daschle�s confirmation as Secretary of HHS was sidetracked by revelations he failed to pay over $140,000 in income taxes. In addition, questions were raised about the validity of some charitable deductions he claimed on his returns. It remains unclear who the President will now nominate to fill this position. While several names have surfaced as potential nominees, there are no clear favorites. A timeline has not been provided by the Administration. The President�s healthcare agenda sits idle as a search for a permanent head of HHS continues. Charles E. Johnson, a Bush appointee, will remain the Acting Secretary until a nominee is named by the President and confirmed by the Senate. Federal Deficit Projected to Reach $1.2 Trillion in 2009 (January 2009)
The non-partisan Congressional Budget Office (CBO) released a report entitled, �The Budget and Economic Outlook: Fiscal Years 2009 to 2019� on January 7. The report projects that the federal deficit for fiscal year 2009 will set a new record and surpass $1.2 trillion. The previous deficit record was set at $454.8 billion in fiscal year 2008, which ended September 30, 2008. The projection does not include the potential costs associated with an economic recovery package that may be enacted in the next few months. In addition, the recently released report projects that the unemployment rate will top nine percent by early 2010. In its report, the CBO said that the United States is in a recession �that will probably be the longest and the deepest since World War II.� The economic picture presented by the report will shape any policy debates that occur in the foreseeable future. The 111th Congress is Now in Session (January 2009)
The House and Senate convened for the 111th Congress on Tuesday, January 6. The House welcomed 21 new members driving the balance of power to 256 democrats and 178 republicans. There is one vacant seat due to President-elect Obama�s selection of Illinois representative Rahm Emanuel as White House Chief of Staff. The Senate welcomed nine new members. As a result, the chamber is now comprised of 57 democrats and 41 republicans. There remain two open seats that have not been filled because of legal and political battles that are ongoing. Additional changes are expected in the Senate as the result of the elevation of at least three other senators to cabinet positions and the vice-presidency. The new congress will be confronted by many challenges including the current financial crisis, expiring appropriations measures and the desire to expand access to health care services, among other things. The ACOI will continue to monitor these and other issues on behalf of its membership. ACOI President Moderates National Health Care Community Forum (January 2009)
ACOI President Humayun Chaudhry, DO, FACOI, moderated a national health care community forum on December 22. Dr. Chaudhry, Health Commissioner for Suffolk County, New York, conducted the forum at Stony Brook University in response to President-elect Barack Obama�s call for suggestions to bring about reform in the nation�s health care delivery system. Comments were provided by physicians, hospital representatives, academicians and the general public. The comments were compiled and sent to the incoming administration�s transition team in an effort to participate in shaping the health care debate that will take place over the next few months in Washington. Federal Health Centers Legislation Signed into Law (December 2008)
The President signed legislation into law reauthorizing three healthcare safety net programs on October 8. The �Health Care Safety Net Act of 2008� (H.R. 1343)(Pub. Law 110-355) amends the Public Health Service Act to reauthorize appropriations for fiscal years 2008-2012 for health centers to provide care in medically underserved areas. Specifically, the Act reauthorizes the Community Health Centers Program, the National Health Service Corps and the Rural Health Care Programs. Prior to the enactment of the legislation, H.R. 1343 was approved overwhelmingly on June 4 and September 24 in the House and Senate, respectively. Healthcare Reform Efforts Take Center Stage for 2009 (December 2008)
Following efforts to address the ailing economy, healthcare reform is poised to achieve a great deal of attention from the President-elect as well as members of the House and Senate. Senator Edward Kennedy, Chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, announced the formation of three working groups to address healthcare reform issues. Specifically, Senator Kennedy announced a group that will focus on prevention and public health; a group that will focus on improving the quality of healthcare; and a group that will address insurance coverage.
In addition to Senator Kennedy�s announcement, Senator Max Baucus, Chairman of the Senate Finance Committee, signaled his interest in advancing healthcare reform legislation through the release of his goals for health system reform. Both Senators Kennedy and Baucus have met to discuss and jurisdictional issues and to identify a path forward when congress returns in January. The ACOI will continue to monitor these discussions and participate where appropriate to advance the interest of osteopathic internists and the patients they care for. Outreach to President-elect Obama�s transition team, Health and Human Services Secretary-designate Thomas Daschle and the newly-elected members of Congress is planned
President Signs Bailout Legislation into Law (October 2008)The President signed the �Emergency Economic Stabilization Act of 2008� (H.R. 1424)(Pub. L. 110-343) into law on October 3. The legislation provides an estimated $700 billion dollars to help stabilize the market by providing the Treasury Secretary the authority to purchase troubled assets. The Act also expands incentives for renewable energy; extends the Federal Deposit Insurance Corporation (FDIC) coverage from $100,000 to $250,000 per bank; extends expiring tax breaks; and requires health insurers to provide mental health coverage at a level similar to coverage provided for other illnesses, among other things. H.R. 1424 was approved by the Senate on October 1 by a vote of 74-25. The House followed suit and approved the legislation by a margin of 263-171 on October 3. Approval by the House and Senate was proceeded by an earlier vote in the House that failed by a margin of 205-228 (H.R. 3997) on September 29. As the vote on H.R. 3997 neared its conclusion and it became apparent that the legislation would fail, the Dow Jones Industrial Average fell by over 777 points, placing additional pressure on Congress to act. Following this defeat, efforts were made in the Senate to amend the text of the legislation in order to garner enough votes to sustain a possible filibuster (60 votes) and move the legislation forward. Additions to H.R. 1424 included the tax-extenders, the FDIC expansion and the mental health parity legislation. It remains unclear how enactment of H.R. 1424, with its large price tag, will impact long term efforts to address domestic policy issues such as health care reform and other matters of importance to physicians and their patients. The ACOI will continue to monitor this important issue. Continuing Resolution Funds Government into 2009 (October 2008)
President Bush signed the �Continuing Appropriations Resolution Act of 2009� (H.R. 2638)(Pub. L. 110-329) into law on September 20. H.R. 2638 was approved by the House on September 24 by a margin of 370-58 and by the Senate on September 27 by a margin of 78-12. The legislation provides full fiscal 2009 funding for military construction, the Department of Defense, Homeland Security and Veteran Affairs. The resolution funds the rest of the government through March 6, 2009 at 2008 levels. Further, the resolution provides disaster relief to flooding and wildfire victims and provides support for the auto industry. As in this instance, continuing resolutions are used to fund government operations when Congress fails to approve some or all of the 12 different appropriation bills that fund the different departments that make up the Federal Government. As a result of this action, fiscal 2009 funding decisions have been left largely to the next Congress and president. NIH Director Steps Down (October 2008)
National Institutes of Health (NIH) Director Elias A. Zerhouni, M.D. announced that he will be stepping down from his position by the end of October. Dr. Zerhouni cited an interest in pursuing other professional opportunities for his decision. He has overseen the NIH, which employees over 18,000 employees, since May, 2002. The NIH consists of 27 institutes and centers focused on medical research. A replacement for Dr. Zerhouni has not been named. House and Senate Reconvene Briefly (September 2008)
The U.S. House of Representatives and Senate remained in recess through the month of August. The House and Senate reconvened on Monday, September 8. It is expected that Congress will remain in session through September before recessing to allow the senators and representatives to return to their districts to prepare for the November 4, 2008 elections. House Committee Approves FDA Regulation of Tobacco (May 2008)
The House Committee on Energy and Commerce approved the �Family Smoking Prevention and Tobacco Control Act� (H.R. 1108) on April 2. The legislation would: require the FDA to regulate certain tobacco products; prohibit the FDA from banning tobacco products and requiring the reduction of nicotine to zero; ban the use of certain flavors that are attractive to children; and give the FDA authority over advertising and labeling of tobacco products, among other things. The Senate Health, Education, Labor and Pensions Committee (HELP) approved legislation (S. 625) similar to H.R. 1108 in 2007. The legislation now awaits consideration by both the full House and Senate. CMS Issues Proposed Rule on Patient Safety (March 2008)
CMS published a proposed rule to implement the �Patient Safety and Quality Improvement Act of 2005� (Pub. L. 109-41) on February 12. The Act establishes the use of Patient Safety Organizations (PSOs) for the purpose of reporting and analyzing patient safety data to improve the quality of health care. Under the proposed rule, the Agency for Healthcare Research and Quality (AHRQ) will implement the process for certification and listing of PSOs. The proposed rule also establishes confidentiality requirements and outlines the instances where disclosures are permitted, among other things. Economic Stimulus Package Signed in to Law (February 2008)
The �Economic Stimulus Act of 2008� (H.R. 5140)(Pub. Law 110-185) was signed into law on February 13. Under the Act, individuals earning less than $75,000 and couples earning less than $150,000 adjusted gross income that paid income taxes during 2007 could be eligible to receive checks of $600 and $1,200, respectively. Eligibility for the program is phased out with payments terminating for individuals earning more than $87,000 and couples earning more than $174,000 in adjusted gross income for 2007. Individuals and couples could also receive an additional $300 per independent child under 17 years of age.
In addition to checks for individuals and couples, the Act provides for business tax breaks. Specifically, the Act allows companies to write off an additional 50 percent of new investment expenditures in 2008 for items subject to depreciation over 20 years or less under current law. Small businesses (companies with overall investments of less than $800,000 in 2008) would be able to write off the entire cost of new investment expenditures up to $250,000. For additional information on the provisions contained in the �Economic Stimulus Act of 2008,� you are encouraged to speak with your tax professional.
President�s 2009 Budget Proposal Seeks Medicare and Medicaid Cuts (February 2008)
The President released his fiscal year 2009 budget proposal on February 4. The proposal would provide $3.1 trillion in government spending. Included in the proposal is a reduction of $200.9 billion in Medicare and Medicaid spending over five years. The proposal would reduce funding by $183 billion and $18 billion, respectively. According to the Administration, the budget would decrease Medicare�s annual growth rate from 7.2 percent to 5 percent and is necessary to maintain the long-term viability of the program. In addition, the President proposed holding spending for the National Institutes of Health (NIH) flat at the 2008 levels of $29.3 billion. Spending for the Centers for Disease Control (CDC) would be cut by $433 million. Funding under Title VII of the Public Health Service Act would be reduced by $240 million. The Food and Drug Administration (FDA) would see a 5.7 percent increase ($130 million) over 2008 levels. Democratic leadership in the U.S. House of Representatives and the U.S. Senate do not appear to support many of the President�s recommended reductions to the nation�s federally funded health care programs. As the budget process continues, the ACOI will carefully monitor budgetary proposals that impact physicians, patients and the overall health care delivery system.
State of the Union Address Touches on Health Care (February 2008)
The President presented to a joint session of Congress his seventh and final State of the Union Address on January 28. A large part of the speech focused on the state of the economy and the war on terror. However, in addition to education, entitlement spending and energy, the President also addressed the state of health care in the nation. Specifically, the President called on Congress to take the following actions: reform the tax code to provide standard deductions for every American who purchases health insurance; expand the availability of Health Savings Accounts (HSAs) and allow for the formation of Association Health Plans (AHPs); continue efforts to improve the adoption of health information technology (HIT); promote the sharing of information by federal agencies to promote greater efficiency and quality within the health care delivery system; and, reform the medical liability system to prevent costly and frivolous lawsuits. The President did not address physician reimbursement under federal health programs such as Medicare and Medicaid. You can read the full text of the speech at www.whitehouse.gov/stateoftheunion/2008/index.html.
Omnibus Appropriations Legislation Approved (January 2008)
The �Consolidated Appropriations Act, 2008� (Pub. L. No. 110-161) was signed into law on December 26, 2007. The Act funds numerous parts of the Federal Government through September 30, 2008. It is expected, however, that supplemental funding legislation will be considered later this year. The Act provides $65.6 billion for the U.S. Department of Health and Human Services (DHHS), $29.2 billion for the National Institutes of Health (NIH) and $1.7 billion for the Food and Drug Administration. In addition, the law provides $287 million for rural healthcare and $2.1 billion for community health centers to provide access to dental and medical services. The legislation also allows for the importation of a 90-day supply of prescription drugs from Canada for personal use, among other things. This provision does not allow for the importation of controlled substances or biologics. The all-encompassing package, which consists of 11 separate appropriation bills, was put together to overcome presidential vetoes, threats thereof and a dwindling calendar on which to advance legislation. The appropriations process for 2009 will begin in earnest as Congress returns from its winter break.
Congratulations to the Health Policy Fellowship Class of 2006 � 2007 (October 2007)
The Health Policy Fellowship Class of 2006 - 2007 was honored in Washington, DC at the American Osteopathic Association�s Bureau on Federal Health Programs meeting on September 7, 2007. The year-long program is designed for individuals who are preparing for leadership roles in the osteopathic profession and positions of influence in health policy. Included in the Class of 2006 � 2007 were osteopathic internists Joseph A. Giaimo, DO, Roy Harris, DO, Robert Hasty, DO and Anthony Ognjan, DO. Each physician completed an extensive research project on significant health policy issues including health information technology, health savings accounts, obesity and patient safety, respectively. These internists join a list of distinguished alumni who have completed the intensive Health Policy Fellowship program. Congratulations on your accomplishments!
Number of Uninsured Americans Increases (October 2007)
According to data recently released by the U.S. Census Bureau, the number of uninsured Americans rose from 44.8 million in 2005 to 47 million in 2006. Children under the age of 18 accounted for 8.7 million uninsured Americans. Texas had the highest rate of individuals lacking insurance coverage at 24.1 percent while Minnesota had the lowest amount of uninsured persons at 8.5 percent. Of the 249.8 million Americans with health insurance in 2006, 59.7 percent were covered for some or all of the year through their employment. These and other statistics are certain to play a role in future health policy debates. You can access this and other statistical information at www.census.gov.
Acting CMS Administrator Named (October 2007)
The White House appointed Kerry N. Weems Acting Director for the Centers for Medicare and Medicaid Services on September 4. Mr. Weems was first nominated by the President to head CMS in early May. While the U.S. Senate Finance Committee conducted a hearing on July 25, the nomination is still pending. A 24-year veteran of the Department of Health and Human Services, Mr. Weems has said that he will push for tougher oversight and an increase in transparency. Additional action on his confirmation has not been scheduled.
Senate Committee Approves Legislation Allowing FDA Oversight of Tobacco Products
(August 2007)
The U.S. Senate Health, Education, Labor and Pensions (HELP) Committee reported favorably the �Family Smoking Prevention and Tobacco Control Act� (S. 625) by a vote of 13-8 on August 1. The legislation gives the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. The legislation would be funded by an approximate 2.5 percent per-pack tax on cigarettes. The legislation is expected to be considered by the full Senate following the August recess. Similar legislation has been introduced in the U.S. House of Representatives where action currently is not scheduled.
Senate Committee Conducts Hearing on Gifts from Pharmaceutical Industry
(July 2007)
The U.S. Senate Special Committee on Aging, Chaired by Herb Kohl (D-WI), conducted a hearing entitled, �Paid to Prescribe?: Exploring the Relationship Between Doctors and the Drug Industry,� on June 27. The Committee heard testimony from physicians, a state legislator and a representative from the pharmaceutical industry examining the impact of pharmaceutical marketing on physicians prescribing activities and the resulting patient care. A few of the physician witnesses presented testimony stating that the large amount of resources spent by pharmaceutical companies on marketing to physicians and on funding various educational activities creates conflicts of interest and ultimately compromises patient care and the quality and independence of scientific research. Other witnesses, including Marjorie Powell, Esq., Senior Assistant General Counsel for the Pharmaceutical Research and Manufactures of America (PhRMA), stated that education of the physician community is important to promote quality health care. Further, Ms. Powell testified that measures are in place to protect the integrity of research and the independence of practicing physicians. Chairman Kohl concluded the hearing by expressing his desire to work in conjunction with Charles E. Grassley (R-IA), Ranking Member of the Senate Committee on Finance, to pursue a national registry of pharmaceutical gifts to physicians. The ACOI will continue to monitor this and similar legislation.
Support Medical Education in Afghanistan (July 2006)
The US military 14th Combat Support Hospital in Afghanistan is seeking donations of medical text books to train local family practice residents in critical care. Reports from the front indicate that some of the text books in use date to the 1950�s. The Combat Support Hospital is in need of gently used, more up-to-date medical text books of all types to support the training of residents. If you are interested in donating texts, they may be sent to Deputy Commander for Clinical Services, Colonel W. Thomas Frank at 14th CSH, TF Med (DCCS), Medical Text Book Project, APO-AE 09354.
Cardiologist Tapped to become Nation�s 18th Surgeon General (June 2007)
President Bush nominated cardiologist James W. Holsinger, M.D., Ph.D., to become the nation�s 18th surgeon general on Thursday, May 24. According to a statement released by President Bush, �As America�s chief health educator, [Holsinger] will be charged with providing the best scientific information available on how Americans can make smart choices that improve their health and reduce their risk of illness and injury.� It is expected that Dr. Holsinger will focus on efforts to combat childhood obesity. Dr. Holsinger�s nomination awaits confirmation by the U.S. Senate.
Agency for Healthcare Research and Quality asked to Examine Medical Errors (May 2007)
U.S. House of Representatives Committee on Energy and Commerce Chairman John Dingell (D-MI), Ranking Member Joe Barton (R-TX) and others sent a letter to the Agency for Healthcare Research and Quality (AHRQ) requesting an investigation into preventable medical errors. The Committee requested that the AHRQ consider pursuing the continued study of medical errors associated with physicians and resident work hours through the Institute of Medicine (IOM). According to the letter sent to the AHRQ, the Committee became interested in the matter following an AHRQ-funded study published by the Public Library of Science entitled, �The Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attention Failures.� The study seemed to support previous concerns that medical residents and interns may cause avoidable adverse events as a result of sleep deprivation and being overworked. The ACOI will continue to monitor this and other activities by Congress and administrative agencies that would impact the training of interns and residents as well as the practice of medicine.
Centers for Medicare and Medicaid Services Administrator Nominated (May 2007)
President George W. Bush announced the nomination of Kerry N. Weems as Administrator of the Centers for Medicare and Medicaid Services (CMS). Mr. Weems, who currently serves as the Department of Health and Human Services (HHS) Deputy Chief of Staff, has worked at HHS for 24 years. The U.S. Senate must confirm the nomination and is not expected to do so for several months. As CMS Administrator, Kerry Weems would be responsible for overseeing the Medicare and Medicaid programs which account for a large part of the nation�s health care spending. CMS is currently under the direction of Acting Administrator Leslie V. Norwalk, Esq. who took the reins following the resignation of Mark McClellan, MD in October 2006.
U.S. House of Representatives and U.S. Senate Approve Budget Blueprint (April 2007)
Both the U.S. House of Representatives and the U.S. Senate recently approved budget resolutions for Fiscal Year 2008, H.R.Con.Res 99 and S.Con.Res 21 respectively, that set federal spending at nearly $3 trillion. Members of the House and Senate must now reconcile the competing budget resolutions and arrive at a concurrent budget resolution. The approved concurrent resolution will not have the effect of law or be subject to a presidential veto. It will, however, set revenue and spending targets for the federal government and will serve as the foundation for tax and spending legislation that, when enacted, will have the force of law. Congress has failed to approve a concurrent budget resolution for three of the last five years. The ACOI will continue to monitor closely the budgetary process as it goes forward. For additional information you may contact Tim McNichol at tmcnichol@acoi.org or by calling toll-free 1-800-327-5183.
President Delivers State of the Union Address (February 2007)
President George W. Bush delivered his seventh State of the Union Address on January 23. The President outlined his vision for the future and put forth domestic and foreign policy recommendations in the areas of health care, energy, education, immigration and the war on terror, among other issues. In the area of health care, the President announced proposals to make basic, private health insurance more available and affordable for Americans and to move health care coverage away from government run programs to private insurers. To accomplish these goals, the President outlined a proposal to create a standard tax deduction for individuals or families of $7,500 or $15,000 respectively for purchasing health insurance. Under his proposal, the tax deductions would be applicable regardless of the type or source of the insurance coverage. Further, the deduction amounts would be adjusted by the Consumer Price Index (CPI) each year. Employer-sponsored health care would loose its tax-exempt status and become taxable income. In addition, the President announced his Affordable Choices Initiative. The initiative is designed to assist states in their efforts to make available private health insurance for low-income uninsured and hard-to-insure individuals and families. According to the White House, the initiative will allocate current Federal health care funding more effectively without creating new entitlements or additional Federal spending. State participation would be voluntary and subject to approval by the Secretary of Health and Human Services (HHS). Further, the President highlighted continued interest in efforts to increase transparency of the health care system; to improve the adoption of health information technology; to expand the use and availability of Health Savings Accounts (HSAs); to promote the formation of Association Health Plans (AHPs); to permit the purchase of health insurance across state lines; to promote the adoption of medical liability reforms to limit costly and frivolous lawsuits; and, to promote prevention, wellness and fitness.
ACOI President Works to Shape AOA Legislative and Regulatory Agenda (February 2007)
ACOI President Joanna R. Pease, DO, FACOI attended the American Osteopathic Association�s (AOA) Bureau on Federal Health Program (BOFHP) meeting in Washington, DC on January 19. Attendees at the meeting heard a congressional panel discuss the impact of the November, 2006 elections and the outlook for health care legislation over the next two years. In addition, AOA staff presented a summary of legislative and regulatory activity. The meeting concluded with a review of the AOA�s Agenda for the 110th Congress, which Dr. Pease and the ACOI Committee on Government Affairs played an integral role in shaping. Robert S. Juhasz, DO, FACOI is the Chair of the Committee on Government Affairs and also serves on the BOFHP. Prior to the meeting, Dr. Pease wrote to Marcelino Oliva, D.O., Chairman of the AOA BOFHP, recommending legislative and regulatory priorities for the AOA and the osteopathic profession as a whole for the next two years. Cognizant of the altered majorities in the House and Senate, ACOI suggested that the Agenda must be shaped with consideration of the policy priorities of the new leadership. The Bureau accepted many of the recommendations put forth by the College, which included suggestions related to physician payment under the Medicare Program, medical liability insurance reform and graduate medical education, among other things. For additional information on the advocacy efforts of the ACOI you may contact Tim McNichol at tmcnichol@acoi.org or by calling toll-free 1-800-327-5183.
110th Congress by the Numbers (January 2007)
The 110th Congress convened at 12 Noon on January 4, 2007. The U.S. Senate is comprised of 49 Democrats, 49 Republicans and two Independents. The two Independents will caucus with the Democrats providing them with control of the Senate. The U.S. House of Representatives is comprised of 237 Democrats and 203 Republicans. A record 90 woman now serve in the House and Senate. In the two chambers there are a combined 11 physicians, three dentists, three nurses, two veterinarians, one psychologist, one optometrist and one pharmacist. There are 216 members and senators involved in law for their profession.
Interested in Serving on Federal Advisory Panels, Commissions and Committees? (January 2007)
The ACOI is working with the American Osteopathic Association to identify and advance qualified internists and subspecialists to appointments on federal advisory panels, commissions and committees. As the ACOI continues its efforts to advance osteopathic internal medicine in Washington, DC, these appointments provide the opportunity for physicians to have an impact on the federal rules and regulations which affect the provision of health care services. Further, such appointments are essential in ensuring that the voices of osteopathic physicians are heard and considered in the development of federal health policy. If you are interested in serving in this capacity, please forward a copy of your curriculum vitae to Tim McNichol at tmcnichol@acoi.org.
Executive Order Issued to Advance Quality and Efficiency Of Federal Health Programs (September 2006)
President Bush signed an Executive Order �Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs� on August 22, 2006. The Order was issued to �ensure that health care programs administered or sponsored by the Federal government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health care quality and price, and better incentives for program beneficiaries, enrollees, and providers.� Programs subject to the Order include the Federal Employees Health Benefit Program (FEHBP), the Medicare Program, programs operated by the Indian Health Service, and TRICARE. It does not apply to Medicaid or the State Children�s Health Insurance Program (SCHIP). The Executive Order directs Federal agencies to utilize, where available, health information technology (HIT) that meets recognized interoperability standards; implement programs measuring the quality of health care services based upon standards established by multi-stakeholders (Transparency of Quality Measurements); make available pricing information and participate in the development of information regarding the overall costs of services for common episodes of care and the treatment of common chronic diseases (Transparency of Pricing Information); and develop and identify approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. Federal agencies are further directed to comply with the provisions of the Executive Order by January 1, 2007.
MedPAC Appointments Announced (May 2006)
The Comptroller General of the United States, General David M. Walker, appointed four new members to the Medicare Payment Advisory Commission (MedPAC) on May 5, 2006. The new Commission members, whose terms will expire in 2009, are Mitra Behroozi, J.D., executive director, 1199SEIU Benefit and Pension Funds; Karen R. Borman, M.D., professor of surgery and vice-chair for surgical education, University of Mississippi Medical Center; Ronald D. Castellanos, M.D., physician, Southwest Florida Urological Associates; and, Douglass Holtz-Eakin, Ph.D., director, Maurice R. Greenberg Center for Geoeconomic Studies and Paul A. Volcker Chair in International Economics Council on Foreign relations. Additional Commission terms expire in 2007 and 2008. American Osteopathic Association Trustee Ray E. Stowers, DO served on MedPAC for six years ending in April 2006. Dr. Stowers is to be commended for his service and outstanding representation of the osteopathic profession. Efforts are underway to secure the appointment of additional osteopathic physicians to this federal advisory panel.
President Releases Proposed Budget for FY 2007 (March 2006)
The President released his $2.77 trillion federal budget proposal for fiscal year 2007 on February 6. The budget proposes cutting non-defense discretionary spending and controlling the growth of mandatory spending. The Department of Health and Human Services (HHS) has been appropriated $676.9 billion for fiscal year 2006. The President proposes funding HHS at $697.7 billion for fiscal year 2007. This increase is a result of a three percent growth in mandatory spending and a four percent reduction in discretionary spending. The budget also proposes controlling the cost of entitlement programs such as Medicare and Social Security. To this end, the budget would reduce Medicare spending by $35.9 billion over five years. Savings under the Medicare program would be achieved through, but is not limited to, the reduction of payments to hospitals, nursing homes and other Medicare providers. Congress is expected to face an uphill battle in efforts to obtain the President�s proposed spending levels in this, an election year. The ACOI will continue to monitor this throughout the year.