by Foon Rhee, deputy national political editor

Could it be a reprise of the stimulus on healthcare?

There are certainly hints that moderate US senators of both parties could determine the fate of President Obama’s agenda yet again.

Obama is holding separate private meetings this morning to discuss healthcare overhaul with Senators Olympia Snowe, a Maine Republican, and Ben Nelson, a Nebraska Democrat. They are among the senators being targeted by new TV ads, launched by Obama’s grassroots organization, that say “it’s time” for healthcare reform.

Nelson and Snowe’s fellow moderate senator from Maine, Susan Collins, played a key role in negotiations to win Senate approval in February for the $787 billion economic recovery package championed by Obama. The stimulus bill passed the House without a single Republican vote, and the administration’s horse-trading focused on satisfying Nelson and Collins, who pushed for a smaller package.

After meeting with Obama, Snowe said the president repeated his wish for Congress to pass a bill before its August recess. “He’s determined to have that happen,” she said on MSNBC.

But Snowe said it’s more important to get bipartisan consensus in the Senate Finance Committee, especially on how to pay for the bill. Supporting a Senate vote in September, she also said she wants to give ample time for all senators and the public to review the bill.

“This deserves a thoughtful process,” she said.

Asked about Senate Finance Chairman Max Baucus saying today that Obama had hindered his efforts to reach a bipartisan deal by opposing a tax on some employer-provided health insurance benefits to help pay for the deal, Snowe said it would be helpful if Obama endorsed a financing approach.

The panel is “working mightily” to find “offsets” and other savings to reduce the cost of the bill. “It’s all part of building a consensus,” she said.

Asked to respond to Baucus, deputy White House press secretary Bill Burton told reporters on Air Force One today, “Nobody said it was going to be easy. And there are obviously bumps along the way to getting to final passage of legislation in both the House and the Senate. But we think that we’ve been able to make a lot of progress. And those comments notwithstanding, this week has been a very great week, if you consider that the House bill and the bill that passed through the HELP Committee are very, very similar. They’re about 80 percent exactly the same.”

Burton refused to say which version of the healthcare bills the president favors, and said Obama remains hopeful for a bipartisan compromise.

“We’re only about midway through this. But he feels very positive about the progress we’ve been able to make,” Burton said. ” And once we get something through the House and through the Senate, we’ll be able to go to conference and really put the rubber to the road and get something done.”

With the power equation in the Senate so tenuous — just last week Al Franken became the 60th Democratic vote, potentially enough to overcome Republican filibuster — Snowe and Collins play an outsized role.

Obama and Senator Edward M. Kennedy of Massachusetts are still holding out hope for a bipartisan deal this year on healthcare.

But those prospects appear to be dimming. The Senate health committee passed its $615 billion plan on a strictly party-line vote on Wednesday.

In the House, little, if any Republican support, is expected in votes planned today in the Education and Labor and the Ways and Means committees on a $1.5 trillion plan that House Democrats presented this week. It would be financed in large measure through a tax surcharge on the highest-income Americans.

“It is extraordinary, the breadth of the bill that is being pushed through and the cost associated with it,” Representative Eric Cantor, the No. 2 Republican in the House, told reporters this morning. “And ultimately, really, the cost is going to be borne by the people of this country — the middle class, the wealthy, those who can least afford it, all of us are going to be paying an astronomical cost at a time that we just cannot afford this ambitious grab.”

Obama, who during the campaign proposed paying for healthcare by limiting tax deduction for high earners, has not endorsed a specific financing plan. But on CBS’s “Early Show” this morning, he said, “Personally, I think the best way to fund it is for people like myself, who’ve been very lucky, to pay a little bit more.”

UPDATE: Today, the American Medical Association endorsed House Democrat’s bill, saying it “includes a broad range of provisions that are key to effective, comprehensive health system reform.”

“I am grateful that the doctors of the AMA have chosen to support health insurance reform that will lower costs, expand coverage, and assure choice and quality health care for all Americans. Along with the nation’s nurses, these doctors are joining the chorus of Americans who know that the time to reform what is broken about our health care system is now,” Obama said in a statement.

The insurance industry, however, said it opposes key elements of the bill, saying a government plan “will cause millions of patients to lose their current coverage.”

Above article published on http://www.boston.com/news/politics/politicalintelligence/2009/07/
fate_of_healthc.html

Delegates call for eliminating Medicare penalties for failing to show “meaningful use” of electronic records by 2015. But some fear incentives could also go.

By Emily Berry, AMNews staff.

Chicago – Physician-delegates at the AMA Annual Meeting in June formally came out against planned penalties included in this year’s federal stimulus bill that would dock Medicare pay for physicians who do not have a qualifying electronic health record.

The “adjustments” start at 1% of the physician’s Medicare fee schedule and are set to begin in 2015, after four years of available incentives for adoption. The penalties are set to increase each subsequent year to a maximum of 5%.

Delegates passed a resolution calling for the Association to ask the federal government to eliminate the penalties and advocate for federal assistance with up-front and maintenance costs of EHR use.

The stimulus package, officially titled the American Recovery and Reinvestment Act of 2009, sets out incentives for both physicians and hospitals who can demonstrate “meaningful use” of an EHR, including the use of an e-prescribing component. Qualifying physicians will be eligible for additional Medicare payments of as much as $44,000 over the course of five years, beginning in 2011.

The national Health IT Policy Committee, an advisory group charged with defining principles for “meaningful use,” released its first draft recommendations June 16, but the Centers for Medicare & Medicaid Services has indicated proposed rules won’t be released until late 2009.

There is a case-by-case exemption written into the law for physicians who can demonstrate “significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access.”

Delegates at the Annual Meeting argued that the penalties violate the AMA’s pay-for-performance policies and unfairly punish physicians who can’t afford the up-front cost of adopting an electronic record system.

“My financial calculations say it’s cheaper for me to take the penalty than to put the system in, and that’s what I’m going to do,” said David McKalip, MD, a neurosurgeon and alternate delegate for the Florida Medical Assn.

No coverage for up-front costs

There are no provisions in the stimulus package that cover the up-front cost of adopting an EHR for a physician in private practice, and some physicians are concerned about buying an EHR now without knowing exactly what type of system will qualify them for incentives.

“Whatever you’re buying now is going to be obsolete in the near future,” said Stephen Sebert, MD, a family physician and president of the West Virginia State Medical Assn.

Other physicians speaking to the issue in reference committee urged delegates to “not throw the baby out with the bathwater” and pointed out the incentives represent the first assistance the government has offered for health IT adoption.

“I think if we ask for this to be rescinded, what we’ll wind up with, possibly, is nothing,” said Steven Kanig, MD, a nephrologist and delegate for the New Mexico Medical Society.

Above article published on

http://www.ama-assn.org/amednews/2009/06/29/prsd0629.htm