With great fanfare, President Obama signed into law the Patient Protection and Affordable Care Act last Tuesday. By a vote of 56-43, the Senate passed an amended version of H.R. 4872, the Reconciliation Bill of 2010 last Thursday. Sens. Lincoln, Pryor, and Ben Nelson joined Republicans in voting against the legislation. Later that evening, by a vote of 220-207, the House passed the amended Reconciliation bill. The bill now goes to President Obama for his signature.
The passage of the Patient Protection and Affordable Care Act and the Reconciliation Bill of 2010 brings to a close the legislative work on comprehensive health care reform that began in November 2008 when Senate Finance Committee Chairman Max Baucus released his “Call to Action” white paper on health care reform.
House and Senate Republicans have already introduced legislation to amend the Patient Protection and Affordable Care Act to require the President, Vice President, Members of Congress and their staff to purchase health care insurance through the Exchange. At least four other pieces of legislation that amend the health care reform law have been introduced, and we expect that Republicans, in particular, will continue to seek changes through legislative action. Republicans are also expected to mount challenges to reform by opposing funding for the newly authorized entities and programs in the Fiscal Year 2011 appropriations bills. Congress will at some point certainly consider technical, if not policy, changes to the newly enacted legislation.
The challenges of implementation now loom large. For example, the Department of Health and Human Services must develop a number of new insurance regulations. The government will also establish a temporary risk-pool for uninsured individuals who have pre-existing conditions and create the health care exchanges in 2014.
The buzz about a Presidential nomination for the Center for Medicare and Medicaid Services Administrator were kicked up again late last week. It is thought that the President could nominate Donald Berwick, a pediatrician and professor at Harvard University, as early as sometime this week. A CMS official has acknowledged that Dr. Berwick has been under consideration for the position, which would require confirmation by the Senate. Charlene Frizzera has served as Acting Administrator since President Obama took office in January 2009.
The Senate adjourned for recess without passing an extension of the Medicare physician fee fix to prevent a 21 percent payment cut from going into effect on April 1. Earlier this month, the House passed the Continuing Extension Act of 2010 to extend the physician fee fix through April 30. The Senate attempted to pass the legislation by unanimous consent, but Senator Tom Coburn of Oklahoma objected. He opposed consideration of the legislation on the basis that the bill is not paid for and would increase the deficit by $9.2 billion. We expect that CMS will issue a notice this week instructing Medicare physicians to hold their claims for some time.
While many are breathing a sigh of relief that the debate on health care reform legislation is done, the difficult work of implementation is just about to begin.
Following House passage of the Senate health care reform legislation, Representative Nathan Deal resigned so he can focus on the Georgia’s governor’s race. Representative John Shimkus of Illinois has been tapped as the new House Energy and Commerce Health Subcommittee Chairman.