Health Reform Update - October 5, 2009

The Senate Finance Committee finished its markup of health reform legislation on October 1. The Committee will reconvene this week to vote on a final bill after it receives an updated score from the Congressional Budget Office (CBO). Senators did not want to vote on the bill without assuring that the total cost of the bill with all amendments was below $900 billion over 10 years. Senator Schumer (D-NY) did not offer amendments on Medicaid or Medicare Disproportionate Share (DSH) payments in the end, although he had filed two that would have reduced the cuts to the levels in the bills passed by committees in the House.

The Senate leadership will be melding the bills passed out of the Senate Finance Committee and the Health, Education, Labor and Pensions (HELP) Committee and sending one bill to the Senate floor some time later this month.

In the House, leadership is meeting with the Chairs of the three committees with health reform jurisdiction (Rangel for Ways and Means, Waxman for Energy and Commerce, and Miller for Education and Labor) to combine their bills for a bill to go to the House floor. We understand that the White House is pressuring the House to get their bill down to a cost of $900 billion over ten years (all three committee bills were over $1 trillion). As part of that process, all potential revenue sources and spending cuts are on the table. Medicaid and Medicare DSH were projected to be cut by $10 billion over 10 years in the Energy and Commerce and Ways and Means bills. We ask you to contact your representative to ask them to weigh in with the leadership or the three chairs to ask them not to increase the DSH cuts beyond the levels passed by committees. DSH is necessary to maintain at adequate levels to help you cover shortfalls from Medicaid, which will expand under health reform, and for the residual uninsured.

Once bills have passed both chambers, they will be reconciled in a conference committee process that is likely to include the chairs of key committees, the leadership and the Obama Administration.