Before Health Reform Stall, ‘We Were Toast’

WASHINGTON—While President Obama is still plugging the
virtually comatose health care reform bill, he told those attending
a Democratic National Committee fundraiser on Thursday that it
could actually die in Congress.

“If Congress decides we’re not going to do it, even after
all the facts are laid out, all the options are clear, then the
American people can make a judgment as to whether this Congress has
done the right thing for them or not. That’s the way
democracy works,” the president said.

The embattled reform effort has been in a precarious position
since Massachusetts voters elected Republican Scott Brown to fill
the Senate seat of the late Ted Kennedy. Brown’s win snuffed
out the Democrats’ filibuster-proof majority in the Senate
and raised serious questions about their ability to get the bill
passed.

That was good news for HME stakeholders, whose own health was at
stake due to a number of provisions in the Senate health reform
bill that included expansion of competitive bidding, elimination
of the first-month purchase option for power wheelchairs, a
manufacturer excise tax and a productivity adjustment.

“It really gives us an opportunity to get back in and kill off
the Senate provisions that were very harmful to the industry.
Before, we were toast,” said John Gallagher, vice president of
government relations for Waterloo, Iowa-based VGM Group.
“We’ve got to regroup and reshape the message and get it
right back out there. This is no time to take a breath.”

Seth Johnson, vice president of government affairs for Exeter,
Pa.-based Pride Mobility Products, agreed, adding that the industry
must remain vigilant.

While the Senate provisions might not be enacted in a future
comprehensive health reform bill, they could surface elsewhere, he
warned. For example, Congress must act before March 1 or physicians
in the Medicare program will take a 21 percent reimbursement
cut—something the powerful American Medical Association and
others have roundly denounced.

“That is something that Congress absolutely will act on sometime
within this month,” Johnson said. Both the House and the Senate
have voted to exempt the “doc fix” bill from pay-go rules and it
does not appear that legislators will look to HME as a pay-for,
“but there is no guarantee they will not try to do that,” Johnson
said.

Legislators would prefer the physicians—who pour money
into legislators’ coffers—not take any cuts, but
that’s not such a popular idea with the public, Gallagher
said.

“The doc fix is a hard sell right now with people unemployed,”
he said, adding that he anticipates legislators will try to sneak
the doc fix into a jobs bill in order to avoid debate.

The creation of jobs has surfaced as the more urgent national
issue above health care, and Obama said at Thursday’s
fundraiser that a jobs package would be moving through the
legislation process over the next several weeks.

That very topic could be a plus for HME, the lobbyists said.
Even as the industry works to get rid of the Senate bill’s
damaging provisions, advocates also now have a window of time
(Gallagher expects the health reform debate to resume in late March
or early April and a bill to be up for a vote in June) to fight the
biggest threat of all: DMEPOS competitive bidding.

“It gives us a real good chance to go back to Congress and say,
‘This is a job-killer. It’s all about elimination of
providers—good, small businesses that will be forced out of
business,’” Gallagher said, adding that under the bidding
program, “the numbers are pretty astronomical when you say nine out
of 10.

“Nine out of every 10 providers will be forced out of business
along with their employees by the government. Is that really what
they want?” he asked.

“Providers are forced to make crazy bids just to survive. So
they make a pact with the devil just to survive and if they win,
they lose,” Gallagher said, because the bids are unsustainable.

Both he and Johnson said that during this grace period,
providers must reach their legislators and hammer home the
arguments against the Senate bill provisions and competitive
bidding.

“We have to keep reaching out to legislators,” Johnson said. “It
is an election year and it is probably going to be a little easier
to get your legislator’s ear than in the past.”

Gallagher said it is critical for all providers, whether or not
they are in the initial competitive bidding areas, to realize they
also are in danger. Third-party payers, he said, will quickly
follow Medicare’s lead and chop reimbursement. “It’s a
downward spiral,” he said.

The goal during this period, he said, is to build more support
for H.R. 3790. The bipartisan, budget-neutral bill would eliminate
DMEPOS competitive bidding. (See related story in this issue.)

“If scored properly, we’ve got [the cost of eliminating
competitive bidding] paid for,” Gallagher said. “We’re not
going there holding out our hand for a handout. We’re going
there saying, ‘Keep us from going under.’”