Infrastructure, Budget Legislation Passed by Senate Contains Positive Improvements for US Health Care

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ACP is pushing for passage of these bills in the House, but is sounding the alarm on mandatory Medicare cuts included in the infrastructure bill

Sept. 3, 2021 (ACP) -- The infrastructure and budget legislation currently in Congress contains elements that are crucial to improving health care in the United States, and the American College of Physicians is pushing hard for their passage.

“[These bills] have the potential to greatly help the health of Americans,” said Dr. George M. Abraham, president of ACP. “The funding that both bills provide would better prioritize the well-being of our communities and all of us who live in them.”

The infrastructure bill now awaits approval in the House of Representatives; and a preliminary version of the budget bill passed the House and Senate in August. The $550 billion Infrastructure Investment and Jobs Act will ensure that all Americans have access to safe drinking water and broadband services that provide vital access to telehealth services. It will also mandate investment in clean energy to reverse the negative health effects associated with climate change.

As ACP noted in its 2018 position paper titled “Addressing Social Determinants to Improve Patient Care and Promote Health Equity,” geography and social conditions deeply affect the health of individual Americans. Investments in safe drinking water and high-speed broadband are “key factors to reduce health inequalities associated with social determinants of health,” Abraham said. “The investments in this legislation provide positive steps to promote health equity and level the playing field to improve the health outcomes of our citizens no matter where they live.”

However, ACP is expressing concern about provisions of the infrastructure bill that will extend mandatory Medicare cuts through 2031 in order to provide $8.7 billion in funding to the plan. “Congress must address this problem, as physician payments have not kept up with inflation,” said George Lyons, ACP director of legislative affairs.

As Lyons explained, a budget deal struck in 2011 allowed a 2 percent “sequestration” cut to Medicare spending to all health care practitioners over nine years. “Federal spending is subject to sequestration until 2022, unless Congress acts to stop the cuts,” he said. “During the COVID-19 pandemic, Congress imposed a moratorium on the Medicare sequester cuts. Unless Congress acts before the end of the year, these cuts will once again continue into next year and extend through 2030 as part of the infrastructure bill.”

ACP has joined with many other frontline health care organizations, including the American Medical Association and a coalition of primary care physicians, in a bid to prevent a 2 percent spending cut from being imposed again as of Jan. 1, 2022. “As internal medicine physicians continue to struggle with the financial challenges imposed by the COVID-19 pandemic,” Abraham said, “these Medicare cuts would deal a devastating blow to their ability to deliver high-quality care to their patients.”

Meanwhile, ACP is closely monitoring the progress of the budget resolution bill. It could add new dental, vision and hearing benefits to Medicare; extend Affordable Care Act premium tax subsidies to those who are at 400 percent of the federal poverty level; and create a new federal health program for Americans in the “Medicaid gap” to allow those who live in states that did not expand Medicaid under Obamacare to receive Medicaid benefits. The bill could also reduce prescription drug costs for patients and save taxpayers hundreds of billions of dollars by enabling Medicare to negotiate drug prices.

Lyons cautioned that while it is likely that both bills will pass, “the passage of the budget reconciliation package is not as certain. If it passes, its scope and size may be reduced to hold down costs. Some Democrats, including the 95-member House Progressive Caucus, will champion for major expansions of Medicare and Medicaid and extended family leave, while other, more moderate Democrats will seek more fiscal constraints in overall spending.”

And, of course, competing interests will be part of the debate. “The pharmaceutical industry will wage a large campaign against provisions to lower prescription drug costs,” Lyons said. “Also, corporations, hedge funds, and wealthy Americans will lobby against any provisions to roll back Trump-era tax cuts to pay for the reconciliation package.”

ACP is pushing for action through various strategies, including:

  • Providing statements and comment letters to the leadership of each jurisdictional congressional committee expressing support for ACP legislative priorities.
  • Reaching out to congressional committee members and their staffs to express concerns and support as the various committees formulate the provisions to be included in the entire reconciliation package.
  • Working with other medical organizations to promote areas of interest and concerns with the package.

Finally, ACP is encouraging its members to take action by writing letters to their congressmen on various aspects of the reconciliation package that are consistent with its legislative priorities.

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