July 24, 2009

Health Care Reform

Work continues on health care reform. As I write today, it is not clear if the House will vote on legislation by the end of next week. The Senate has delayed a vote on its health care legislation until the Fall in an effort to reach consensus on many unresolved issues. On the House side legislation is currently held up in the House Energy and Commerce Committee primarily over concerns raised by the conservative Blue Dog Democrats. It is unclear when or if that impasse will be broken.

I am very concerned about one proposal that resulted from negotiations between the White House and the Blue Dog Democrats. It is still only a proposal and has not been added to the bill. At this point we don’t know if the proposal will move forward. However, if it does, it would pose serious problems for the Commonwealth of Massachusetts, for urban hospitals everywhere in the United States, and for academic medical centers in particular. It would essentially create a broader version of the current MedPAC. Under existing law, MedPAC makes recommendations to Congress on Medicare payment policy. In the past, MedPAC has recommended severe cuts in Indirect Medical Education payments (these are the payments that keep the cost of educating America’s doctors within reach). Massachusetts has several world-class medical schools and teaching hospitals, and, if this proposal were to become law, initial estimates indicate we could lose $700 million over the next ten years. This loss would be in addition to any other cuts that may be imposed by other aspects of health care reform. That would create significant financial difficulties for some medical schools and might lead to the closing of some major teaching hospitals.

Based on what I know of the most recent proposal, MedPAC would be restructured so that its recommendations would go into effect in 30 days unless 2/3 of Congress voted to override them. Again, this is just a proposal, but one that I am watching closely as this health care debate continues.

Pay-Go

On Wednesday the House passed H.R. 2920: Statutory Pay-As-You-Go Act. This legislation reinstates rules that were in place during the nineties but that the Republican-led Congress allowed to expire in 2002. This very simple rule requires nearly all legislation to be revenue neutral with all new spending or new tax cuts offset by equal cuts to other spending. I voted YES. H.R. 2920 passed and the entire vote is recorded below:

Appropriations

Over the last two weeks the House has continued work on the FY 2010 appropriations bills with consideration of H.R. 3170: Financial Services and General Government Appropriations bill. This legislation increases funding for a number of key agencies in order to continue strengthening financial oversight efforts, including the Securities and Exchange Commission (SEC) and the Federal Trade Commission. H.R. 3170 requires the Treasury Department to provide regular updates to the House Appropriations Committee on the Troubled Asset Relief Program (TARP) and provides additional resources to the Small Business Administration. I voted YES. H.R. 3170 passed and the entire vote is recorded below:

On July 17th the House passed H.R. 3183: Energy and Water Development and Related Agencies Appropriations bill. This legislation provides more than $2 billion for technology investments that incorporate more efficient uses of energy. Funding is also provided for research into solar energy and biofuels, and for weatherization grants. More than $200 million has been dedicated to modernizing the country’s electrical grid. H.R. 3183 provides for key investments in science, including almost $5 billion for scientific research. This measure also provides funding for the Army Corps of Engineers so that they may continue maintenance work on our navigation infrastructure, continue flood protection work and plan for the upgrade of our water infrastructure. I voted YES. H.R. 3183 passed and the entire vote is recorded below:

This week, the House considered two additional appropriations bills. First to the floor was H.R. 3288: Departments of Transportation, Housing and Urban Development and related agencies for FY 2010. This legislation provides more that $10 billion to the Federal Transit Administration (FTA) for grant programs and improvements to our nation’s rail systems. Additional funding is provided for highway improvements and repairs, and for upgrades to Air Traffic Control. H.R. 3288 increases funding for a number of housing related programs, including veterans programs and section 8 housing. Programs that revitalize neighborhoods are also provided additional funding, including the Community Development Block Grant program and HOPE VI. I voted YES. H.R. 3288 passed and the entire vote is recorded below:

Finally on Friday the House considered H.R. 3293: Department of Labor, Health and Human Services and Education Appropriations for FY 2010. This legislation provides additional funding for Title I grants and for underperforming schools. It invests in employment training for those who have lost jobs in this difficult economy and additional funding to help states cover unemployment insurance obligations. H.R. 3293 increases funding for the National Institutes of Health (NIH) to conduct biomedical research and provides resources to help train health care workers where there are shortages. I voted YES. H.R. 3293 passed and the entire vote is recorded below:

What's Up Next

Next week the House is expected to complete its consideration of FY 2010 appropriations bills, most of which still await Senate action. Additionally, the House may take up health care reform.