Reform Proposals Threatening; Senate Vote This Week Key

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.”