Date Published: 10 February 2009
Senate Passes Economic Stimulus Bill With Health Care Provisions
On February 10, 2009, the U.S. Senate passed an amended version of H.R. 1, the “American Recovery and Reinvestment Act of 2009,” by a vote of 61-37. While the health care related provisions are very similar to those that were included in the bill the House passed on January 28, the following are a few of the key differences:
Both bills provide COBRA subsidies for workers who have been involuntarily terminated from their jobs (and their families) for 12 months. The House subsidy amounts to 65% of premium costs and the Senate subsidy is 50%.
The House bill would also allow COBRA-eligible workers age 55 and older, and those who have worked for an employer for 10 years or more, to retain COBRA coverage at their own expense beyond the 18 months provided under current law.
The increased federal medical assistance percentage (FMAP) for Medicaid is 4.9% in the House bill and 7.6% in the Senate bill.
The House bill includes $600 million to address shortages in the primary care workforce; the Senate bill does not include this provision. Funds for prevention and wellness, pandemic preparedness, and other public health initiatives were also deleted from the Senate bill.
The House bill would repeal the 3% withholding tax on government contractors (including Medicare providers) that is scheduled to take effect on December 31, 2010; the Senate bill would delay implementation of the withholding tax for one year.
The incentive payment structures for health information technology (HIT) adoption differ. In particular, the imposition of Medicare payment reductions for those providers who are not “meaningful users” of HIT would begin in 2015 in the Senate bill, one year earlier than in the House bill.
There were widespread reports and commentaries this week that mischaracterize some provisions of the package pertaining to HIT and to comparative effectiveness research. To clarify, neither version of the bill would create a federal system for electronically tracking patients’ medical treatments or for monitoring compliance with federal treatment standards. While the legislation would impose financial penalties for those who do not adopt HIT in the next 6-7 years, those penalties bear no relation to individual treatment decisions made by physicians. Further, neither bill would create a single new bureaucracy to determine whether treatments are appropriate or cost effective. In fact, both versions of the bill incorporate by reference provisions in current law that prohibit the Secretary of Health and Human Services from including mandates establishing national clinical guidelines or national coverage decisions in clinical comparative effectiveness research.
Source: American Medical Association (AMA).