Children’s Health Insurance Program President Obama signed H.R. 2, the bill reauthorizing until 2013 the Children’s Health Insurance Program, formerly known as the State Children’s Health Insurance Program (SCHIP). Without legislative action, CHIP funding would have expired March 31, 2009. The bill would maintain coverage for the approximately seven million currently enrolled in CHIP, while expanding coverage to nearly four million additional children. The Congressional Research Service estimates that projected allotments under the new law would increase by 87 percent for Pennsylvania, an increase from $167 million to $312.5 million.
In addition, President Obama issued a memo directing the secretary of Health and Human Services to withdraw previous letters (commonly referred to as the “August 17 directives”) to state health officials that “limited coverage under several state plans that otherwise would have covered additional, uninsured children.”
HAP supported the bill.
Stimulus On February 17, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). This bill incorporates continued federal investment in the health care system. Many of the issues that HAP advocated for in support of investment in hospitals were included in this legislation; for example, Health Information Technology dollars and an FMAP increase to Pennsylvania.
Federal Fiscal Year 2010 Budget To demonstrate the administration’s commitment to heath care reform, President Obama’s fiscal year 2010 budget proposal calls for the creation of a $630 billion “reserve fund” over ten years to be designated for future health care reform proposals that would lower costs and expand coverage. The President’s budget proposal calls for $316 billion in savings to the Medicare program over ten years:
Budget Proposals Directly Affecting Hospitals
Reduces Medicare payments to hospitals with high readmission rates (savings of $8.430 billion over ten years).
Bundles payments for hospital care and post-acute care (savings of $17.840 billion over ten years).
Creates new quality incentive payments for hospitals (savings of $12.090 billion over ten years).
Includes $329.6 billion for future Medicare physician update payments.
Other Health Care Components of Budget Proposals
Establishes competitive bidding for Medicare Advantage (savings of $176.6 billion).
Allocates $6 billion within the National Institutes for Health to support cancer research.
Designates $330 million to reduce the shortage of health care providers in medically underserved areas by expanding loan repayment programs for physicians, nurses, and dentists.
Allocates $73 million to improve rural health care access and quality.
Builds upon the Health Information Technology and Comparative Research provisions contained in the American Recovery and Reinvestment Act.
Proposes to ensure appropriate Medicaid payments via the use of the National Correct Coding Initiative (savings of $620 million over ten years).
Congressional Action The U.S. House and Senate have passed Fiscal Year 2010 Budget Resolutions, H Con Res 85 and S Con Res 13, respectively. The budget outlines provide for overall spending of $3.5 trillion. The House resolution includes reconciliation, a legislative tool to bypass a Senate filibuster, for allowing health care reform legislation, while the Senate resolution does not. Should a conference agreement that includes reconciliation language pass both the House and Senate, this will diminish the need for bipartisan agreement on health care reform and limit the negotiating power of moderate Republicans, such as Pennsylvania Senator Arlen Specter.
Labor Issues U.S. Senator Tom Harkin (D-IA) and Representative George Miller (D-CA) introduced the Employee Free Choice Act, commonly referred to as “card check.” S. 560 and H.R. 1409, respectively, would amend the National Labor Relations Act by requiring employers to recognize a labor union solely through the “card check” process, thus permitting unions to avoid secret-ballot elections where employees make decisions free from interference. In addition, the bill would mandate onerous first-contract binding arbitration. HAP continues to oppose the bill and voice our concerns to the Pennsylvania congressional delegation.
On March 24, 2009, U.S. Senator Arlen Specter (R-PA) announced his intention to oppose the Employee Free Choice Act, effectively ending the bill’s chances of passage in the current Congress. In light of this announcement, news reports suggest Democrat leaders might consider a compromise to win the support of Republican senators needed to avoid a filibuster.
On March 5, 2009, Representative Joe Sestak (D-PA) introduced the “National Labor Relations Modernization Act,” H.R. 1355. The legislation includes three provisions; interest arbitration for first contacts, enhanced penalties on employers for certain violations or alleged violations, and a provision designed to give unions greater access to employer property. HAP is opposed to the bill.
Critical Access Hospitals HAP supported and encouraged members of the Pennsylvania delegation representing critical access hospitals (CAHs) and our U.S. Senators to cosponsor H.R. 668 and S. 307 respectively. The bills, titled The Critical Access Hospital Flexibility Act of 2009, would provide flexibility in how CAHs measure patient census. This flexibility in measurement of patient bed days or through a patient’s veteran status, assures access to primary and emergency health care services in rural areas.
Physician-Owned Hospitals HAP remains committed to passing legislation to prohibit physician self-referral to facilities in which they have an ownership interest. Despite being successful in having legislative language included in the House version of the SCHIP bill, the provision was dropped during final negotiations with the Senate. HAP will continue to push to have the provision included in other legislative vehicles.
