NASW Remains Active on Health Care Reform
Congress is working now to reconcile differences on health care reform legislation. Negotiating room is limited by the very close 60 vote margin in the Senate for initial passage. Democratic leaders must find compromises on divisive issues such as abortion coverage, taxes and fees to pay for expanded coverage, inclusion of a government-run plan, and methods to expand coverage to those unable to pay full costs. Negotiations are expected to continue until the end of the month.
Democratic leaders will work out their differences with a small group of health committee chairmen, supported by their key staff. NASW has expressed its preferences among key provisions in the House and Senate bills. Among the differences NASW has weighed in on are Medicare payments to clinical social workers serving nursing home residents, workforce provisions under the Social Work Reinvestment Act, the public option, and reproductive choice. NASW Executive Director Elizabeth Clark’s latest letter to congressional negotiators is here. NASW is aware the final bill may not measure up to all the hopes of its members, but we continue to press for improvements to the bill as it moves toward passage. To stay in touch with congressional developments and NASW’s response, please follow our webpage here.
Update on CSW Medicare payments in Federal Legislation
Clinical social workers that bill Medicare independently under Part B face two large rate cuts at the start of 2010. These include a five percent cut in psychotherapy rates due to an expiring provision in Medicare law and a 21 percent cut in all Medicare rates due to the Sustainable Growth Rate (SGR) formula that affects all Part B practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually cuts payments to providers. Each year Congress has intervened to postpone the SGR cut, but due to the costs of a permanent repeal, Congress has not agreed to a solution to the underlying flaws in the formula. NASW supports a permanent change in the Medicare formula (see our letter here). Last month Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. The latest agreement leaves Congress just this month and next to enact another plan to address the SGR formula, and they plan to pass it separately and following an agreement on health care reform.
In addition to the SGR reduction, psychotherapy rates face a five percent cut due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists have worked together for several years to ensure the psychotherapy rate cut also does not go into effect. An increase for psychotherapy billing codes is included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). NASW is now pressing Congress to include the House provision, and we are organizing social worker support for the House provision. NASW’s Action Alert on health care reform items will appear shortly on our website here.
NASW Joins Opposition to Independent Medicare Board
NASW has joined with 75 other advocacy organizations in opposition to the establishment of a Medicare Independent Payment Advisory Board (IPAB) included in the Senate-passed health reform bill. The purpose of the IPAB is to reduce the per capita rate of growth in Medicare spending, but in most years Medicare’s per capita growth rate has been below or equal to the growth rate in private sector health spending. The IPAB reductions would be in addition to $400-500 billion in provider payment reductions already included in health care reform legislation. NASW and its coalition partners believe further cuts of this magnitude could jeopardize both access to care for Medicare beneficiaries and even the infrastructure of the entire health care system.
The coalition believes the IPAB, which would be appointed by the President, would assume too much authority over the Medicare program to make recommendations to reduce per capita Medicare spending regardless of whether spending is growing faster than general health care inflation. The coalition argues that replacing elected officials with political appointments from the President does not remove politics from the equation. Furthermore, the proposal usurps congressional authority over the Medicare program, and greatly limits the ability of Medicare beneficiaries, advocates and providers to work with Congress to improve the program, making it especially difficult to include coverage of new and better treatments, procedures and technologies.
Comparison of House and Senate Packages
Social workers interested in learning more details about the impact of the House and Senate versions of health reform legislation on coverage, affordability, and costs may wish to view a report by the Commonwealth Fund, a respected source of comparative health policy information. See: “The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs.”
Kaiser Family Foundation Analysis Available
If you would like to see how the proposals may affect individuals, view the Kaiser Family Foundation analysis on how individuals might be affected.