ATLANTA — Elimination of the first-month purchase option for standard power wheelchairs, expansion of competitive bidding areas and a manufacturer’s tax are all still on the health care reform table. While providers in Round 1 are hopeful that competitive bidding still can be stopped, industry advocates across all sectors are girding for battle on the reform proposals in both the House and the Senate.
Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, got the legislative ball rolling on Sept. 16 with his 220-page proposal dubbed “America’s Healthy Future Act of 2009,” and the ripples from that document continue to be felt. (For a rundown on the bill's provisions that would affect HME, see Chairman's Mark Draws Fire, Sept. 17.)
“The vote in the Senate will be key this week,” said John Gallagher, vice president of government relations for VGM, Waterloo, Iowa. “We must get the competitive bidding ramp-up provision removed.”
Currently, CMS has targeted Oct. 21 as the date it will open the bid window on the bidding program’s Round 1 rebid. A recent message from the agency said it is on track to meet that date.
According to Rob Brant, founder of the Accredited Medical Equipment Providers of America, that ramp-up would expand competitive bidding from 79 to 100 MSAs (including Washington, D.C., Baltimore, and Philadelphia), a move he says could actually help to foster unity among providers who thought they would not be involved in Round 2.
“I don’t wish competitive bidding on anyone,” said Brant, CEO and general manager of City Medical Services, North Miami Beach, Fla. “But it may help to unite the industry against competitive bidding.”
Baucus’ proposal still features a line, found at the top of page 195, which reads: “Starting in 2011, the [HHS] Secretary has the authority to use information on payments determined in competitive acquisition areas to adjust payments for items and services in non-competitive acquisition areas.”
“The way this thing reads, you could say we’re all in Round 1,” Brant told HomeCare Monday in a previous interview. “If the secretary wanted to, it sounds like she [Kathleen Sebelius, secretary of Health and Human Services] could decide that instead of doing a Round 2, she could just take the competitive bidding rates from Round 1 and implement them in non competitive acquisition areas.”
Meanwhile, the so-called “public option” is destined to be October’s political hot potato in what is sure to be a lesson in civics and deal-making. Eventually, the Senate’s final bill will have to be reconciled with the House final for still more votes. Instead of health insurance sold by the government, which many prominent Democrats favor (including House Speaker Nancy Pelosi, D-Calif.), Baucus’ plan would allow cooperatives to sell insurance in competition with private industry. The provision is viewed as a concession to Republicans who strongly oppose the idea of the federal government selling insurance.
Effect on Small Business
Among independent home care providers, small business provisions within health care reform could have a big impact.
On Sept 29, the National Small Business Association brought its voice to the table with the release of the 2009 Small Business Health Care Reform Survey.
“NSBA’s small-business members have expressed wide-spread concern that the various proposals offered to date don’t include the kind of cost-containment policies that would ensure the affordability of a required health insurance policy,” wrote NSBA officials in a release accompanying the survey results.
According to the survey summary:
- 73 percent stated their opposition to a requirement that employers make a financial contribution to employees’ health plan or pay some kind of fee.
- 62 percent of small-business owners believe passing some kind of health care reform in the next year is important.
- 92 percent of small business owners are planning for an increase in their premiums in the coming year. Although the average expected increase is 13 percent, one-fifth anticipates premium increases of more than 20 percent next year.
- Premium increases have a significant impact on job growth, forcing 31 percent of small businesses to hold off on hiring a new employee, and 19 percent to lay off an employee.
- Nearly 80 percent believe that offering health insurance provides their small company a competitive advantage in recruiting and retaining top quality employees.
- Among those not currently offering employees health insurance, 63 percent said they would do so if it were more affordable.
- The NSBA “has been urging Congress to enact reform that won't make costs go up — reform that guarantees access, affordability and quality, while ensuring American small businesses are no longer at a competitive disadvantage.”
