Boswell is a swing vote on health care reform

by: desmoinesdem

Thu Oct 22, 2009 at 10:19:41 AM CDT

The versions of the House bill approved by the House Ways and Means Committee and  House Education and Labor Committee contain a Medicare tie-in that has two crucial  characteristics:
    1.  Providers participating in Medicare would automatically be considered participating  providers in the new public plan, although they would have the right to opt out.
    2.  Initial payments to providers would be set at Medicare rates plus 5 percent. After  three years, the Secretary of Health and Human Services could adjust rates. But  during the crucial start-up period, the public plan would be able to piggyback on  Medicare's payment methodology. 17    

     These are good provisions. They would be even better if they included an explicit  protection of providers' rights to join the public plan. Private plans (at least those that  participate in the exchange) should be prohibited from setting as a condition of participation  in their networks that providers not join the public plan.
     By contrast, the House Energy and Commerce Committee approved the House bill  with amendments that preserve only the first of these two elements. 18 Providers participating  in Medicare would be presumed to participate in the new public plan (but, again, allowed to  opt out). 19 However, rather than setting the rates the public plan would pay providers on the  basis of Medicare rates, the Secretary of Health and Human Services would have to  "negotiate" rates directly with providers. 20 These rates in the aggregate would have to be  between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening  Americans as health care consumers and taxpayers alike. It threatens the viability of the  public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.

Click here to download Hacker's full report, which includes analysis of the Senate HELP Committee's bill.

When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won't bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the "Medicare plus 5 percent" public option.

Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, "lean yes" or "lean no" on the stronger public option. Representative Leonard Boswell (IA-03) is on that list. It's not clear whether he is undecided or leaning one way or the other. I have sought clarification from his office and will update this post when I hear back.

You know the drill. Boswell needs to hear from as many constituents as possible. The "Medicare plus 5 percent" version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call Boswell's office rather than e-mail, because phone calls are harder for staffers to ignore. Office contact information:

Washington DC Office
Phone: (202) 225-3806
Fax: (202) 225-5608

Iowa District Office
Phone: (515) 282-1909
Fax: (515) 282-1785
Toll Free Phone: (888) 432-1984

In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change "the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system." After the jump I've posted a joint press release explaining how this deal will affect Medicare reimbursement rates.

UPDATE: Supposedly there are at least 218 votes in the House for the "robust" public option. The deal on Medicare reimbursement rates helped secure some extra votes for the public option. Also, the House bill will strip the insurance industry of its anti-trust exemption.

CORRECTION: Apparently we don't have 218 votes for the stronger public option after all.

FOR IMMEDIATE RELEASE
Thursday October 22, 2009

Boswell, Loebsack, and Braley Announce Final Medicare Reform Agreement
Introduce Final Legislative Language to Incentivize Quality Care

Washington, DC - Reps. Leonard Boswell, Dave Loebsack, and Bruce Braley today announced finalization of a major breakthrough on the issue of Medicare payment reform. Final legislative language was introduced today that will reward states like  Iowa for providing high-quality, low-cost care. Braley, Boswell and Loebsack have been outspoken advocates for changing the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system.

Boswell, Loebsack, and Braley helped negotiate a compromise adding language to the healthcare reform bill changing Medicare to a quality-based payment system in two years.  Specifically, the compromise would (1) require Medicare to conduct a two-year study on a value-based system, and (2) at the end of the two year study period, Medicare would switch to a quality-based system unless Congress specifically cast a vote to disallow that change.

"This agreement rewards States like Iowa who have put patients and their care first," said Congressman Loebsack. "By reforming the Medicare payment system to reward high quality care we are creating a system where everyone wins.  This deal achieves significant cost-savings while incentivizing the kind of care that all Americans want and deserve.  Iowa has been a leader in this area, and I am proud that we are finally able to highlight and fairly compensate their achievements."

"My colleagues and I here today represent states and districts that provide top-notch quality care, yet our providers are reimbursed from the Medicare program at some of the lowest rates in the nation," Congressman Boswell said. "Throughout my career in Congress, I have worked to bring attention to how this disparity negatively impacts Iowa's providers and have sought to help them receive the reimbursements they deserve. Now, many of our clinics and hospitals are at a breaking point. The two studies that we have proposed will pave the way for all doctors to be paid fairly for the great care that they provide. Health care reform must move us forward. Let's take a hard look at where we are now and ask how we can truly help our doctors to continue to provide excellent care, while bending the cost curve and expanding coverage.  I hope that my colleagues will keep sharp eye on the structure of reform and how it will impact the public option in a final health care bill.  It must be robust in that it covers all people.  But it must also be fair."

"This compromise represents a major breakthrough in healthcare reform that will save taxpayers billions of dollars and reduce costly, unneeded procedures that don't improve patient outcomes," Congressman Braley said.  "Our healthcare system should reward the best care.  A quality-based approach for Medicare will reduce costs to taxpayers and increase the quality of care for everyone, all while rewarding doctors in states like Iowa who provide the most efficient and effective healthcare.

Medicare currently operates under a fee-for-service system, basing payments to doctors and hospitals on the amount of procedures completed and the number of patients seen.  This system creates a financial incentive to order more and more procedures.  Ironically, according to many studies, this increased number of procedures does not result in better outcomes for patients.

Boswell, Loebsack, and Braley have strongly advocated a switch to a Medicare payment system based on value and quality, which determines payments based on procedures' effect on patient health.