House passes Senate reform bill, Reconciliation Act to mixed reactions

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The House of Representatives Sunday approved the Senate version of healthcare reform legislation by a vote of 219-212. Later in the evening, the House cleared its package of amendments, the Health Care and Education Affordability Reconciliation Act of 2010, by a vote of 220-211. The reconciliation bill will now go to the Senate, where Democrats need 51 votes to send it to President Barack Obama to sign into law.

The 10-year, $940-billion package, including both the Senate bill and the Reconciliation Act, is expected to extend health insurance coverage to approximately 32 million people by 2019, according to a preliminary estimate by the Congressional Budget Office (CBO). The bill will leave about 23 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants), according to CBO.  The Reconciliation Act also will mandate that almost every American carry health insurance, and will result in new taxes for those who do not comply with the individual mandate. This provision is already garnering law suits, according to media reports.

In addition to the payroll tax in the Senate bill, the reconciliation bill would add a 3.8 percent Medicare tax on investment income imposed on individuals who earn more than $200,000 a year and joint tax filers who declare more than $250,000 in earnings.

The Reconciliation Act imposes a medical device tax equal to 2.9 percent of the price of the device on the manufacturer, producer or importer of those devices. The act also takes steps to “close the donut hole” for those patients covered under on the Medicare part D prescription drug plan as of Jan. 1, 2011, in line with the Patient Protection and Affordable Care Act.

The various industry medical groups have expressed varied opinions on the value of the Senate bill and the reconciliation package.

The American Medical Association called the bill’s passage “historic” and “an important step toward providing coverage to all Americans and improving our nation’s health system.” AMA President J. James Rohack, MD, said: “Those who have insurance will see improvements right away: lifetime caps on coverage end; children can stay on parents’ policies until age 26 and insurance companies can’t cancel coverage except in the case of fraud.”

While the
American College of Cardiology (ACC) called the bill a “start,” the college faulted “several onerous initiatives, including the creation of an ‘independent payment advisory board’ and prohibitions on physician-owned hospitals.” The ACC also faulted Congress for not including delivery and payment system reforms that provide incentives for improvement of quality and outcomes, nor repealing the current sustainable growth rate formula used to calculate Medicare physician payment. Finally, the college suggested that the bill should have included tort reform as well.

In defense of the imaging community, the American College of Radiology (ACR) “strongly opposes medical imaging cuts contained in the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) which will shift necessary imaging care to large hospitals, increase the cost to Medicare of appropriate imaging [and] produce longer commutes and wait times for patients to receive care.”

Specifically, beginning in 2011, the bill would raise the imaging equipment utilization rate assumption, the time during office hours that imaging equipment is assumed to be in operation, from the current 50 percent rate to 75 percent. According to the ACR, this would apply to all diagnostic imaging equipment priced over $1 million, which includes MR and CT machines. The Senate healthcare reform bill would have set the equipment utilization rate for advanced diagnostic imaging services at 65 percent through 2012, 70 percent in 2013 and 75 percent in 2014 and beyond.

Finally, the act expands the authority of the secretary of health and human services  to track down and penalize providers that are found to be fraudulent, either through restricting disclosures or through delinquent tax debt.