House Passes Health Reform - Is it Good For Rural? Yes...and No.
After over fourteen hours of debate on the House floor Saturday, the House of Representatives finished its final vote on the Affordable Healthcare for America Act (H.R. 3962). With a vote of 220 to 215, the bill was officially PASSED through the first of the two Capitol wings. One lone Republican voted in favor of the bill, Representative Joseph Cao of Louisiana, while 39 Democrats voted against it.
Despite facing skepticism that they would not have enough favorable votes, leadership pushed forward and brought the bill to the floor early Saturday morning. On the floor, the bill was both denounced and hailed, with controversial debate lasting into the night.
Leadership only allowed a few amendments to be brought up for debate, including one offered by Representative Bart Stupak (D-MI-01) seeking to tighten the bill's restrictions on federal funding for abortions. The amendment passed with a tally of 240-194. Additionally, House Republican leadership offered an amendment seeking to replace the entire bill with its own version, which was voted down 176-258.
Speaking in terms of rural health, though, and the bill was both good and bad.
Good, in that it seeks to narrow the gap in the rural health workforce with support of things like the National Health Service Corps (NHSC), graduate medical education (GME), and primary care incentives for rural doctors. Other positive provisions, such as widening the 340B prescription drug discount program, and extending several important rural Medicare programs that will soon expire were very positive steps to ensuring rural access. Additionally, and we have the House Blue Dogs to thank for this, the payment structure associated with the House version’s proposed public option was changed at the last minute to allow for a negotiated rate payments, which will better account for geographic factors when determining reimbursements. Previously, the proposed method for reimbursement was to tie it to current Medicare, and add five percent, or “Medicare Plus 5.”
Bad, however, in that many issues important to rural America were left by the wayside. The bill left out many Critical Access Hospitals (CAH) provisions, including current bipartisan legislation to allow CAHs flexibility in their bed counts to allow for fluctuations in patient loads, reinstating individual states’ rights to deem hospitals as “necessary providers,” eliminating the CAH “isolation test” for rural ambulance services, and addressing unfair treatment in the Stimulus bill’s HIT adoption incentives. Furthermore, it bill left out current legislation to finally update rural health clinic (RHC) reimbursement for inflation, another one that would ensure certified registered nurse anesthetists are reimbursed for anesthesia services, and many others too lengthy to list here.
Additionally, the NRHA is disappointed that Congressman Greg Walden’s amendment to ensure rural representation on MedPAC and the proposed health commission, which was stripped out by leadership behind closed doors, was not allowed a full vote on the House floor. The provision was debated in the previous night’s Rules Committee hearing on the bill, with many members from both sides of the aisle hailing it as a strong bi-partisan effort, but ultimately (likely due to whoever stripped it in the first place’s fear that it would be reinstated because of its broad, bipartisan support) it was not allowed to be brought up on the floor for a full vote.
(For the NRHA's health reform website, which includes information on both the positive and not-so-positive provisions of the House bill, click here)
Now, with this monumental step taken, the focus will be shifted to the Senate, who has still not received a final score from the Congressional Budget Office (CBO). Though much, much work is left to be done, health reform is one step closer to being complete.