House Health Care Bill Summary and Discussion

H.R. 3961 - Medicare Physician Payment Reform Act of 2009

http://docs.house.gov/rules/health/111_sgr1.pdf

COMPANION LEGISLATIION TO HEALTH REFORM

As the House considers the Affordable Health Care for America Act, it ill also take up legislation to permanently reform the way Medicare ays physicians. The legislation will repeal a 21 percent fee reduction cheduled for January 2010 and replace it with a stable system that ends the cycle of threats of ever-larger fee cuts followed by short-term patches. Permanent reform of physician payments in Medicare will guarantee that Medicare beneficiaries continue to enjoy the excellent
access to care that they do today. It will also follow the President's lead by ending a budget gimmick that artificially reduces the deficit by assuming physician payments will be cut by 40 percent over the next several years even though Congress has consistently intervened to
prevent those cuts from occurring.

PERMANENT PHYSICIAN PAYMENT REFORM

Preserves seniors'access to their doctors with a guaranteed update in 2010. Replaces the pending 21 percent fee cut with an update for 2010 based on the Medicare economic index while a new payment system is being put in place.

Fairer growth targets to keep doctors'pay steady. Wipes away accumulated deficits from current spending targets to provide for a fresh start, but still holds physicians accountable for spending
growth. Excludes items not paid under the Medicare physician fee schedule such as chemotherapy drugs and laboratory services from revised growth targets.

Promotes primary care that can keep you healthier longer. Provides an extra growth allowance for primary care services to promote access to primary care practitioners in Medicare and throughout the health care system.

Encourages integrated care so your doctors communicate on your care. encourages the formation of Accountable Care Organizations which incentivize physicians to take responsibility for improving quality and reducing costs. Accountable Care Organizations may "opt out"of the national spending targets and establish their own organization-specific targets.

FISCAL RESPONSIBIILITY

The Medicare Physician Payment Reform legislation will be considered in the House under a procedure which will add the text of H.R. 2920, the statutory PAYGO Act of 2009, as passed by the House on July 22nd before being sent to the Senate. The "pay as you go"principle of budget
discipline requires Congress to find a way to pay for any new spending, outside of an economic crisis. The Statutory PAYGO Act would make that principle law. A previous Congress established the policy for paying Medicare doctors, so the update for 2010 is not a new policy to be paid for. The Statutory PAYGO Act would apply this principle to all new tax and spending policies, and would allow Congress to exclude the impact of continuing policies currently in place, including Medicare payments to physicians. The Medicare Physician Payment Reform Act would not increase total payments to physicians above what they are today and therefore, would not be subject to the paygo requirement. 

The legislation is consistent with President Obama’s overall goals of building on what works within the current health care system by strengthening employer-provided care, while fixing what is broken. The bill will ensure that 97 percent of Americans will be covered by a health care plan that is both affordable and offers quality, standard benefits.  The House Committees on Education and Labor, Ways and Means, and Energy and Commerce  worked together in an unprecedented way as one committee to develop the proposal for health care reform.

The key principles of legislation include, among other things:

 

Increasing choice and competition. First, the bill will protect and improve consumers’ choices.
 

•      If an individual likes their current plan, they will be able to keep it.

•      For individuals who either aren’t currently covered, or wanted to enroll in a new health care plan, the proposal will establish a health care exchange where consumers can select from a menu of affordable, quality health care options: either a new public health insurance plan or a plan offered by private insurers. People will have similar choices that members of Congress have.

•      This new marketplace will reduce costs, create competition that leads to better care for every American, and keep private insurers honest. Patients and doctors will have control over decisions about their health care, instead of insurance companies.

Giving Americans peace of mind. Second, the legislation will ensure that Americans have portable, secure health care plans – so that they won’t lose care if their employer drops their plan or they lose their job.
 

•      Every American who receives coverage through the exchange will have a plan that includes standardized, comprehensive and quality health care benefits. 

•      It will end increases in premiums or denials of care based on pre-existing conditions, age, race, or gender.

•      The proposal will also eliminate co-pays for preventative care, cap out-of-pocket expenses, and guarantee catastrophic coverage that protects every American from bankruptcy.

Improving quality of care for every American. Third, the legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.
 

•      Guarantees that every child in America will have health care coverage that includes dental and vision benefits.

•      Provides better preventative and wellness care. Every health care plan offered through the exchange will cover preventative care.

•      Grows the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.

•      Strengthens Medicare and Medicaid so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

Ensuring shared responsibility. Fourth, the bill will ensure that individuals, employers, and the federal government all share responsibility for a quality and affordable health care system.
 

•      Employers who currently offer coverage will be able to continue offering coverage to workers. Employers who don’t currently offer coverage could choose to cover their workers or pay a penalty.

•      All individuals would be required to get coverage, either through their employer or the exchange, or pay a penalty.

•      The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.

Protecting consumers and reducing waste, fraud, and abuse. Fifth, the legislation will put the interests of consumers first, protect them from any problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.
 

•      Provides complete transparency in plans in the health exchange so that consumers have the clear, complete information needed to select the plan that best meets their needs.

    * Establishes Consumer Advocacy Offices as part of the exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.

•      Will identify and eliminate waste, fraud, and abuse by simplifying paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.

Some common myths about the Health Care Reform bill and Medicare:

MYTH: Medicare Advantage plans run by private insurance companies have
been able to provide better value to U.S. taxpayers than traditional
Medicare.

FACT:  According to the nonpartisan Medicare Payment Advisory Commission, U.S. taxpayers pay 14 percent more on average to private Medicare Advantage plans to cover Medicare beneficiaries than it would cost traditional Medicare to cover them.

These overpayments to private insurers were created in the Medicare Modernization Act, which the Republican-controlled Congress passed in 2003 and President George W. Bush signed into law.

When the Medicare Advantage program was created, insurance companies said that they would offer coverage for less than it was costing the government under traditional Medicare to provide the same services.  Today, this promise has been broken and the taxpayers are paying the price - these Medicare Advantage plans are receiving 14 percent more.

On average, this giveaway to private insurers costs an extra $1,000 per enrollee.  This adds up to an extra $12 billion a year-and that cost is passed on to all Medicare beneficiaries.

The nonpartisan Medicare Payment Advisory Commission has recommended phasing out these overpayments to Medicare Advantage - which is what the America's Affordable Health Choices Act does.


MYTH:  The overpayments to private Medicare Advantage plans mean better coverage for seniors.

FACT: Very little of the extra money going to private plans under Medicare Advantage goes to beneficiaries.  Most of these taxpayer funds are used to pad the profit margins of private insurers.

According to a study by the Robert Wood Johnson Foundation, only 14 cents for every extra dollar given to Medicare Advantage (MA) plans end up translating into additional benefits.  The other 86 cents goes into the pockets of the insurance companies.

The independent Medicare Payment Advisory Commission notes that the quality of care of traditional Medicare users and MA users are fairly similar -- while MA users actually reported more problems accessing specialists.


MYTH:  The current system of Medicare Advantage plans, despite the overpayments, is a good investment for everyone - including America's seniors.

FACT:  Everyone pays the price for these overpayments - including the 77 percent of Medicare beneficiaries who are enrolled in traditional Medicare.  According to the Chief Actuary for the Medicare program, seniors in traditional Medicare pay higher premiums to subsidize Medicare Advantage plans - a typical couple paying an additional $90 a year.

The Chief Actuary has also stated that the overpayments to the Medicare Advantage program speeds up the depletion of the Medicare trust fund by 18 months and threatens the long-term solvency of Medicare.


MYTH:  Enactment of the House health insurance reform bill will mean the elimination of private Medicare Advantage plans.

FACT:  The House health insurance reform bill does not eliminate Medicare Advantage plans - instead, it simply phases out the overpayments going to these plans.  Indeed, the Congressional Budget Office projects that most private Medicare Advantage plans would continue to operate, once the current overpayments are phased out.

Under the House bill, Medicare Advantage plans that are able to operate efficiently and provide extra value to their enrollees through care coordination will continue to flourish.


MYTH:  Enactment of the House health insurance reform bill will lead to worse health care coverage for Medicare Advantage enrollees.

FACT:  As was seen above, most of the extra money going to private plans under Medicare Advantage - which the House bill phases out - does not go to seniors for additional benefits.  According to the study by the Robert Wood Johnson Foundation, 86 percent of this extra money simply goes into the pockets of the insurance companies.  Hence, the phasing out of these overpayments will mostly impact insurers' extra profits - and not seniors.

Additionally, the House bill makes reforms to Medicare Advantage that will improve the coverage of care for seniors enrolled in those plans.  Currently, some Medicare Advantage plans offer lower cost-sharing for drugs and vision care but higher cost-sharing for services such as hospitalizations and home health services. As a result, seniors can end up spending more out-of-pocket under a Medicare Advantage plan, not less.

The House bill contains key provisions that limit cost-sharing requirements in Medicare Advantage plans to the amount charged for the same services in traditional Medicare coverage - which can end up saving seniors enrolled in certain Medicare Advantage plans thousands of dollars.

How the Health Care Reform bill will impact the 7th Congressional District of Illinois

America’s Affordable Health Choices Act would provide significant benefits in the 7th Congressional District of Illinois:  up to 13,600 small businesses could receive tax credits to provide coverage to their employees; 5,100 seniors would avoid the donut hole in Medicare Part D; health care providers would receive payment for $404 million in uncompensated care each year; and 103,000 uninsured individuals would gain access to high-quality, affordable health insurance.
 

•      Help for small businesses.  Under the legislation, small businesses with 25 employees or less and average wages of less than $40,000 qualify for tax credits of up to 50% of the costs of providing health insurance.  There are up to 13,600 small businesses in the district that could qualify for these credits.

•       Help for seniors with drug costs in the Part D donut hole.  Each year, 5,100 seniors in the district hit the donut hole and are forced to pay their full drug costs, despite having Part D drug coverage.  The legislation would provide them with immediate relief, cutting brand name drug costs in the donut hole by 50%, and ultimately eliminate the donut hole.

•      Relieving the burden of uncompensated care for hospitals and health care providers.  In 2008, health care providers in the district provided $404 million worth of uncompensated care, care that was provided to individuals who lacked insurance coverage and were unable to pay their bills.  Under the legislation, these costs of uncompensated care would be virtually eliminated.

•      Coverage of the uninsured.  There are 123,000 uninsured individuals in the district, 20% of the district.  The Congressional Budget Office estimates that nationwide, 97% of all Americans will have insurance coverage when the bill takes effect.  If this benchmark is reached in the district, 103,000 people who currently do not have health insurance will receive coverage.

•      No deficit spending.  The cost of health care reform under the legislation is fully paid for:  half through making the Medicare and Medicaid program more efficient and half through a surtax on the income of the wealthiest individuals.  This surtax would affect only 7,400 households in the district.  The surtax would not affect 97.3% of taxpayers in the district. 

This analysis is based upon the following sources:  the Gallup-Healthways Survey (data on the uninsured); the U.S. Census (data on small businesses); the Centers for Medicare and Medicaid Services (data on the Part D donut hole, health care-related bankruptcies (based on analysis of PACER court records), and uncompensated care); and the House Committee on Ways and Means (data on the surtax).

 

COSTS OF INACTION:

Last year, more than half of all Americans postponed medical care or skipped their medication because they couldn't afford it.
 

•    The total cost of health care for the American family is project to INCREASE $1,800 EVERY YEAR.

•    Monthly premiums continue to rise at three times the rate of wages.

•    The average American family already pays $1,100 more a year to cover the cost of 50 million uninsured Americans.

•    More and more small businesses are forced to choose between covering their employees and staying afloat.

•    State and local governments' skyrocketing health costs are crowding out spending on services like public safety and schools.

•    Growth in Medicare and Medicaid continues to be the number one driver of crushing long-term federal budget deficits.

10 Principles Guiding the Merger of the Three House Committee Versions of the HR3200 Base Bill

1. ENDS INSURANCE COMPANY DISCRIMINATION-America's Affordable Health Choices Act will stop insurance companies from denying coverage to Americans with pre-existing conditions such as heart disease, cancer or diabetes and from hiking up rates or dropping coverage for those who get sick.

2. MAKES COVERAGE MORE AFFORDABLE-The House bill will rein in rising health costs for American families and small businesses-introducing competition that will drive premiums down, capping out-of-pocket spending, ensuring no more copays for preventive care, ensuring no yearly caps on what the insurance company will cover, and providing premium subsidies for those who need them. For small businesses, tax credits will help them cover their workers and eliminating health status rating means they won't pay higher premiums based on their employees' health status.

3. IMPROVES CHOICE AND COMPETITION-In most states today, one insurance company controls nearly half the market. To increase competition and keep insurance companies honest, the House bill provides those who must buy their own insurance the choice between private plans and a public health insurance plan. The nonpartisan Congressional Budget Office (CBO) estimates that this public health insurance plan would save taxpayers tens of billions of dollars.

4. ENSURES QUALITY COVERAGE FOR 97% OF AMERICANS-The CBO estimates that the House bill will result in health care coverage for 97% of Americans. This will lead to significantly reducing the current cost of providing uncompensated care for 46 million Americans, and result in lower costs for everyone and savings to the economy.

5. DOES NOT ADD ONE DIME TO THE DEFICIT-According to CBO, the health insurance reform policies of the House bill are deficit-neutral, while covering 97% of Americans with quality affordable health care. (Under the budget adopted earlier this year, the bill's provisions extending Medicare physician payment rates are not new policies that must be paid for.)

6. IMPROVES OUR FOCUS ON WELLNESS AND PREVENTION-The House bill will work to change the focus of our health care system from treating sickness to promoting wellness with several provisions such as eliminating out-of-pocket costs for recommended preventive services, strengthening community-based wellness services, and rewarding primary care.

7. IMPROVES QUALITY-The House bill ensures that it is doctors and patients -not insurance companies-making health care decisions. More family doctors and nurses will enter the workforce-helping guarantee access. It moves us toward a system rewarding the quality of care-for instance through accountable care organizations and medical homes.

8. STRENGTHENS MEDICARE-The bill improves Medicare: making sure doctors don't get a 21% pay cut-so they keep seeing Medicare patients; extending Medicare's financial solvency by 5 years; improving coordination of care and reducing errors for seniors with conditions like high blood pressure and diabetes; eliminating the prescription drug "donut hole" coverage gap over a period of years; and providing free preventive care and wellness check-ups.

9. CUTS DOWN ON FRAUD, WASTE AND ABUSE-The House bill will strengthen oversight and enforcement measures to cut down on fraud, waste and abuse in the health care system, which is estimated to cost more than $60 billion every year.

10. LOWERS COSTS OVER THE LONG TERM-The House bill rewards care that prevents hospital readmissions, promotes doctors working together to coordinate your care better, cuts waste and fraud, invests in prevention and wellness, strengthens primary care, and reforms reimbursement to provide incentives for the quality, not the volume, of services.

Please click on the following links to view text of the legislation as well as background information and summaries of various provisions:

America's Affordable Health Choices Act: Complete Bill Text (HR 3200)
America's Affordable Health Choices Act: Summary

Summary and Description of Revenue Provisions in HR 3200

What's In the Health Care Reform Bill for You?
Controlling Health Care Costs
Paying for Health Care Reform

The Health Insurance Exchange
Public Health Insurance Option
Shared Responsibility
Guaranteed Benefits

Making Coverage Affordable
Consumer Protections and Insurance Market Reforms
Strengthening the Nation's Health Workforce
Delivery System Reform

Protecting Program Integrity by Preventing Waste, Fraud and Abuse
Strengthening Medicare
Improving the Medicare Part D Drug Program
Maintaining and Improving Medicaid
Preventing Disease and Improving the Public's Health

A letter from 303 Organizations Supporting HR 3200’s public health and prevention strategies
AARP
AFL-CIO
AFSCME
AIDS Institute
Alliance for Better Health Care Coalition:
            AARP
            Academy of Managed Care Pharmacy
            Aetna
            AFL-CIO
            Alliance of Community Health Plans
            American society of Health-System Pharmacists
            Center for Medical Consumers
            Coalition for Health Services Research
            Consumers Union
            Community Catalyst
            CVS Caremark
            Express Scripts
            Group Health Cooperative
            Health Dialog
            Kaiser Permanente
            Marshfield Clinic
            National Partnership for Women & Families
            SEIU
American Academy of Family Physicians
American Academy of Nursing
American College of Obstetricians and Gynecologists
American College of Physicians
American College of Surgeons
American Medical Association
American Osteopathic Association
American Psychiatric Association
American Public Health Association
Association of Departments of Family Medicine
Association of Family Medicine Residency Directors
Association for Professionals in Infection Control and Epidemiology
Association of Maternal and Child Health Programs
Association of State and Territorial Health Officials
Breast Cancer Action
Campaign for Tobacco-Free Kids
Cancer Prevention and Treatment Fund
Center for Medical Advocacy
Center for Medical Consumers
Coalition of Full Service Community Hospitals
Communications Workers of America
Consumers Union
Council of State and Territorial Epidemiologists
Doctors for America
Families USA
Government Accountability Project
Healthcare for America Now
Infectious Diseases Society of America
International Association of Firefighters
International Union of Bricklayers and Allied Craftworkers
Main Street Alliance
March of Dimes
National Association of Community Health Centers
National Association of County & City Health Officials
National Breast Cancer Coalition
National Coalition on Health Care
National Consumers League
National Council for Community Behavioral Healthcare
National Education Association
National Medical Association
National Physicians Alliance
National Women’s Health Network
National Women’s Law Center
North American Primary Care Research Group
Our Bodies Ourselves
Pew Charitable Trusts & Community Catalyst
SEIU
Society of General Internal Medicine
Society of Teachers of Family Medicine
Society for Healthcare Epidemiology of America
TMJ Association
Trust for America’s Health
United American Nurses
United Auto Workers
United Steelworkers
US PIRG, Federation of State PIRGs
US Women’s Chamber of Commerce
Voices for America’s Children
YMCA

MYTH: More than 100 million Americans would be forced onto a
government-run health plan under the House bill.

First of all, under this bill, no one can ever be "forced onto a government-
run health plan." Under this bill, the public health insurance plan is available
to all those using the Exchange. All those using the Exchange will have a
choice of options  various private plans, as well as the public plan. If an
employer is providing their employees health insurance through the
Exchange, it is the employee, not the employer, choosing the plan. (Under
the bill, in the first two years of the Exchange, small employers may
participate; in later years, the Administration has the discretion to permit
larger employers to participate but there is no timeline for this participation.)
 
Second, the nonpartisan Congressional Budget Office predicts the number of
Americans in private insurance plans will actually increase under the bill
(rather than millions being forced out of private plans and into a public plan).
 
Thirdly, the nonpartisan CBO has estimated that, by 2019, about 9 or 10
million Americans will be enrolled in the public plan. CBO projects
that two-thirds using the Exchange will choose a private plan   not the public
plan. Even if more Americans end up choosing the public plan, it will be their
choice, no one can force them into the plan.

MYTH: Millions of Americans would lose the employer-provided health care
they have now, under the House bill.

The nonpartisan CBO has found that, under the bill, not only would millions
of Americans not lose their employer-provided coverage, employer-provided
coverage would actually increase. Specifically, the CBO projects that under the
House bill, by 2019, 164 million people would be covered by employer-
provided insurance, compared to 162 million under current law. The House
bill builds on the current employer-provided health care system, rather than
eroding it.

MYTH: The House bill makes cuts in Medicare that are damaging to seniors
and takes away choices for millions of seniors.

The bill requires hospitals, doctors, and pharmaceutical companies to
achieve key efficiencies and eliminate waste in Medicare (including
eliminating overpayments that are driving up profits for Medicare Advantage
plans) and toughens our ability to root out fraud and abuse, but does not
make cuts that hurt seniors. It also does nothing to take away choices for
seniors.

On the contrary, the bill includes several key provisions that improve
Medicare benefits for seniors, including the following:

•    Phases in completely filling in the "donut hole" in the Medicare prescription
drug benefit (where drug costs are not reimbursed at certain levels),
potentially savings seniors thousands of dollars a year.

•    Eliminates co-payments and deductibles for preventive services under
Medicare.

•    Limits cost-sharing requirements in Medicare Advantage plans to the
amount charged for the same services in traditional Medicare coverage.

•    Improves the low-income subsidy programs in Medicare, such as by
increasing asset limits for programs that help Medicare beneficiaries pay
premiums and cost-sharing.

MYTH: The House bill does nothing to control health care costs.

To the contrary, the House bill includes numerous provisions to both achieve
cost savings over the next 10 years, as well as to "bend the cost curve" over
the long-term. First of all, according to the nonpartisan CBO, this bill achieves
net savings in Medicare and Medicaid of $465 billion over the next 10 years.
For example, these savings include:

•     $156 billion in savings by eliminating overpayments to private Medicare
Advantage plans over 10 years;

•     $102 billion in savings by incorporating productivity adjustments into
Medicare payment updates to hospitals; and

•     About $110 billion in savings by codifying the White House-PhRMA
agreement and also requiring that drug companies provide rebates for
individuals enrolled in Medicare and Medicaid that are at least as large as the
Medicaid rebates that were provided prior to the enactment of Medicare Part
D.
 
The bill includes numerous provisions to "bend the cost curve" over the
long-term. These provisions are particularly aimed at changing the incentive
structure so that instead of rewarding the quantity of care, we are rewarding
the quality of care. These reforms   which will also improve care -- include:

•     Promotes Accountable Care Organizations that provide for hospitals and
doctors working together to manage and coordinate care;

•     Creates incentives to reduce preventable hospital readmissions that reward
transition planning and coordination for patients.

•     Establishes pilot projects to test "bundling" payment methodology under
which one payment would be made   rather than separate payments   to any
combination of a physician, acute and post-acute providers.

•     Promotes "medical homes" where physicians and nurse practitioners focus
on ensuring patient care is coordinated and comprehensive.

•     Promotes "shared decisionmaking" with physicians and patients, which has
been shown to keep health care costs down and patients fully involved in
their care.
 
The bill also includes numerous other provisions to control costs, such as
provisions for improving payment accuracy in Medicare and Medicaid;
significantly expanding investments in prevention and wellness programs;
strengthening primary care; and investing in the health care workforce.

MYTH: The House bill pays for health care reform with a "small business tax"
that will kill 1.6 million jobs.

Roughly half of the cost of the bill is paid for by achieving significant
efficiencies and savings in Medicare and Medicaid; roughly the other half is
paid for through a graduated surcharge on a portion of the income of the top
1%.

This graduated surcharge is not a "small business tax." Only the wealthiest
1.2% of American households will pay the surcharge, on just a portion of their
income.
 
This surcharge will have only a modest impact on America's small business
community. According to the nonpartisan Joint Committee on Taxation, only
4.1 percent of all small business owners would pay the surcharge, using the
broadest definition of a small business owner (i.e., any individual with as little
as $1 in small business income).

Of the 4.1 percent paying the surcharge, half earn less than one-third of their
income from small businesses   not what we think of as truly "small business
owners."

Only 1.1 percent would pay the top rate among them, hedge fund
managers, private equity fund managers, lawyers and lobbyists making
millions of dollars a year.

Finally, recent history contradicts the claim that a surtax on the wealthiest
Americans kills jobs. Critics of President Clinton's economic plan made this
argument in the early 1990s. Subsequent history, however, contradicted this
claim: average annual small business job growth was 2.3% in the Clinton
years, when taxes on the wealthiest households were increased, and was
1.0% in the Bush years, when they were cut.

MYTH: The health care reforms in the House bill will add to the deficit.

On July 17, the CBO released estimates confirming that the health insurance
reform policies in the bill are deficit-neutral over the 10-year budget window
-- even producing a $6 billion surplus. CBO estimated that the cost of the bill's
insurance reforms was $1.042 trillion, while the bill's cost savings and
revenues totaled $1.048 trillion. CBO estimated that these reforms will
provide affordable coverage for 97 percent of Americans two years after the
program starts.

As was reported in the press, CBO also estimated that the overall bill had a
net cost of $239 billion over 10 years -- but this is entirely due to additional
provisions in the bill to maintain current Medicare physician payment rates,
costing $245 billion over 10 years (by preventing scheduled draconian cuts.)

The House agreed earlier this year that this $245 billion cost should be
exempt from PAYGO. Indeed, maintaining current Medicare physician
payment rates has bipartisan support. If Congress fails to act, physician
payments under Medicare will be slashed by 21 percent on January 1st 
which would likely result in millions of seniors losing access to their doctor.