Texas Republican Rep. Michael Burgess took a strong stand on the new health care reform law yesterday morning, arguing that opponents must stop its implementation by targeting its funding. He also predicted that there would not be a permanent fix to the Medicare sustainable growth rate until at least after the 2010 election.
Burgess, a licensed obstetrician and the top Republican on the House Energy and Commerce Health Subcommittee, told attendees at a Health Affairs Media Breakfast that while repeal of the new law is unlikely; shutting down funding to implement it could be just as effective. Such a move is “an opportunity for those of us who think it’s a bad product,” Burgess said. He added that Republicans have not changed their opposition to the “badly flawed” Patient Protection and Affordable Care Act in the three months since it became law.
Burgess stressed that there are no positives about this law. For instance, while the law supports an idea he supports – voluntary Accountable Care Organizations – he maintains that this concept was already moving forward without the new law. ACOs are single entities that coordinate all of a patient’s medical needs as a way to bring down costs.
The congressman also panned the bill’s widely supported effort to base doctors’ payment upon quality, rather than quantity, of care. Instead, Burgess came to the defense of the current fee-for-service system where the provider is paid for each individual service rendered to a patient. The congressman argued that doctors are “so goal directed that we need that impetus” of FFS as motivation to provide the best possible care. But he conceded that the vast majority of people do not take this view.
Burgess noted that an early sign of problems with the law has been the Department of Health and Human Services’ inability to meet multiple deadlines for its implementation. HHS should be called forward to explain these lapses, but the House Energy and Commerce Committee has shown no interest in doing so, he argued.
For example, the federal government has failed to meet the May deadline to establish the definition of “medically underserved populations.” Also, HHS was supposed to establish an advisory committee in May to design and implement an advertising campaign to educate young women about breast cancer and breast health, but has yet to do so.
While the attorney general in his state, as well as many others, have filed lawsuits to overturn the law, Burgess said he and other opponents cannot rely solely on this strategy. There is a potential political solution as well, with Burgess looking for the next election to be a referendum on the law.
His hope is that even if Democrats maintain control of the House, the heat they take for this new law will make many of them more open to stopping it. He also predicted a possible “sea change” in Congress, with more physicians seeking House seats than any time in the past 100 years. There are 46 doctors, 40 of whom are Republicans, who are vying for seats, he added. This is the result of doctors’ dissatisfaction with the new law and the way it was passed, Burgess said.
Part of physicians’ concerns involve Congress’ failure to fix funding of the sustainable growth rate (SGR), which ties physician payment rates to Medicare spending for physician services and the growth rate of the overall economy. Doctors recently faced a 21.5 percent cut in their fees, which was later addressed by a temporary extension. Instead, lawmakers should have found a permanent fix for the SGR, Burgess said, adding that the specter of cuts is the number one roadblock for the elderly to get health care.
Part of the blame for this falls on the American Medical Association, who helped negotiate the final bill language. They failed to adequately represent their members, he said. “Why they didn’t do a better job, I don’t know.”
Despite this pressing need, Burgess told reporters that there is no chance a permanent fix will take place before the 2010 election. The temporary extension runs out on November 30, but there just isn’t the time for the lame duck Congress to make long-term changes, he said. Instead, another short-term extension or “budget gimmick” will be necessary. However, when an attempt at a permanent fix occurs, Republicans are not unified on whether the permanent fix needs to be completely paid for or if it can add to the deficit, he said.
Finally, Burgess saw no benefit in the law’s plan to reduce Medicare costs through a payment advisory board. Even though Congress could not be trusted to act on its own to fix the SGR, an independent panel is also not the answer to problems with the healthcare system, he said, counting repeal of the proposed Medicare Independent Payment Advisory Board as one of his top targets. Other targets include a new tax on medical device manufacturers.
Beginning in 2014, the board would make annual recommendations on changes in Medicare payment if Medicare spending is projected to exceed specified targets. The payment board’s recommendations would become law if Congress does not substitute an alternative proposal that achieves equivalent savings.
Such an unelected board is “a very unsatisfactory way to run the people’s business,” he said, noting that it is Congress’ responsibility to make tough budgetary choices. While many of the current members of Congress do not seem willing to do so, he said the answer is to elect those who will, not turn the authority over to someone else.