Health & Public Policy Committee Report
By Robert McLean, M.D., FACP
Who is looking out for your interests as a practicing internist? Do not expect the trial lawyers or the health insurance industry and their lobbyists in Hartford or Washington, D.C. to be explaining how we physicians need certain legislative fixes. We must speak for ourselves, and when we actually do in an effective manner, we are frequently heard.
The past six months of legislative activity demonstrates how true this can be, but it also shows where we cannot let up on making our viewpoints heard - for the sake of our ability to continue to practice medicine effectively without excessive administrative burdens or "hassles" but also for the sake of our patients, who are increasingly becoming mere pawns in our ever-complicated health care system.
After a tremendous grassroots effort from all of organized medicine, the Medicare reimbursement fee cut of 4.4%, which was scheduled to take effect this past winter was averted. However, Congress did not make any permanent changes to the flawed "sustainable growth rate formula", and subsequently CMS recently projected that payments under the physician fee schedule will likely be cut again in 2004. While the recurrence of this struggle so immediately is clearly frustrating, Rep. Nancy Johnson is immersed in this problem and clearly remains a strong physician advocate on the problems with Medicare reimbursement formulas. We need to remind our federal legislators whenever possible how cuts in Medicare reimbursement impact our ability to care for Medicare patients and possibly affect access of Medicare patients to health care. Many physicians effectively involved their patients in contacting legislators on this issue (including many of our CT ACP colleagues), and I think we will be repeating this effort again.
On the topic of Medicare, there has been a large effort (spearheaded by Rep. Johnson) to pass legislation making Medicare easier to use and fairer to physicians. The "Medicare Regulatory and Contracting Reform Act of 2001" was passed in the House of the last Congress but was never addressed by the Senate. The "Medicare Regulatory and Contracting Reform Act of 2003" (H.R.810) has made its way through House Committees and is expected to come before the House for a vote soon. We need to encourage our House Representatives to pass this important bill and then urge our Senators to introduce and co-sponsor similar legislation.
Recently, the most publicized issue has been malpractice liability reform. At the state level, this has been the major issue all year, and there has been tremendous work done by CSMS and its lobbyists on this issue, despite the efforts by the trial lawyers to obfuscate the issue. Much needs to be done to improve the current liability system, but the most immediate impact would be caps on non-economic damages. Despite arguments made by opponents of such proposals, this strategy has clearly proven helpful in other states. The Connecticut legislation has been bogged down with budget issues, which has led legislative leaders (largely Senator Kevin Sullivan) to try to put off this malpractice reform issue. We cannot accept this! Most recently as of late May, a working group of legislators (consisting of chairmen of most of the involved committees) was given the task of developing a comprehensive piece of legislation. Can this group, Chaired by Representative Mary Fritz and Senator Joe Crisco, complete its task before this session ends in June? If not, these legislators will need to hear from us frequently over the next few months to urge them to action. At the federal level, malpractice reform did pass the House in March with the "HEALTH Act of 2003" (H.R.5), but it was a mostly party line vote, likely reflective of the historical support given to Democrats by the trial lawyer lobby. Our Democratic Representatives (DeLauro and Larson) need to hear from you that you are disappointed with their vote, and our Democratic Senators need to be urged to take up and support similar legislation in the Senate. Remember, President Bush has stated he will sign such legislation into law when it comes to him!
Last but not least, the ACP has tried to be pro-active and politically realistic in efforts to achieve health care coverage for all Americans with the publication last year of a Seven-Year Plan, which has now made its way into actual legislation. In early May, Senator Jeff Bingaham (D-NM) introduced S.1030 "The Health Coverage, Affordability, Responsibility, and Equity Act of 2003" (HealthCARE Act of 2003) which in great detail calls for an expansion of coverage in steps over the next five years so that all Americans will have access to affordable health care coverage by January 1, 2009. The crisis of the health care uninsured in our country is being addressed by most of the current Democratic Presidential candidates (including internist Dr. Howard Dean), and so we hope that the country's attention can be focused on this topic once again. We need to encourage our legislators to consider co-sponsoring this most-comprehensive health plan.
Other health issues, which remain on the back burner of legislative priorities, include the Patients Bill of Rights (maybe proving less critical as increasing number of court cases are finding that health insurance companies can no longer find protection by making claims under ERISA exemptions), Physician anti-trust relief, and a Medicare prescription drug plan. Unfortunately, a stagnant economy and budget struggles at both the state and federal level have limited what really can be done or even expected in terms of health care issues.
As detailed in a separate column by Dr. Podell, a group of 4 Connecticut colleagues traveled to D.C. for the annual "ACP Leadership Day" to discuss all these issues and more with our federal legislators and staff. That activity gives our organization a one-day personal presence in the legislators' offices, but we must remember to make our presence felt many other days as well.
Our D.C. ACP office works hard with lobbyists to advocate on these many issues which affect us, but we need to remain personally committed as well. Letters asking for support of legislation and telling very specific personal stories about your patients or practices do have an impact. As well, follow-up letters after specific votes to express appreciation or disappointment remind the legislators that we are truly paying attention! When such letters are particularly timely or crucial, I will notify a list of those physicians in our Chapter willing to participate. If you are not already on my list and getting such e-mail requests but would be willing to have your voice be heard, then please contact me at firstname.lastname@example.org. It is time to get involved!