House Passes Health-Care Reform; Obama Signs Bill Into Law

Ending 11 months of debate and wrangling, the House of Representatives passed its health-care reform bill, which includes various provisions that impact the HME industry, in a historic vote of 219 in support of the reform to 212 opposed that concluded late Sunday night, March 21.

The vote sent the bill to President Obama, who signed it into law on Tuesday, March 23. Also, the House approved various changes to the bill that will be sent to the Senate as a budget reconciliation bill.

The budget reconciliation process in the Senate caps debate at a maximum of 20 hours and requires only a simple majority to pass, negating the chance of any GOP filibuster. However, because the House passed the Senate version of the bill, the bill will become law as soon as the President signs it.

The health-care reform bill will commit $938 billion over the next 10 years to provide health-care to more than 32 million uninsured Americans, according to the Congressional Budget Office. It would add 16 million Medicaid beneficiaries, as well as subsidize private-payor coverage for low- and middle-income recipients.

Additionally the bill will implement increased protections for beneficiaries to ensure coverage, such as prohibitions against insurers from removing coverage when beneficiaries suddenly become ill, or blocking coverage due to preexisting conditions.

However, the bill also includes various provisions from the Senate bill that impact HME providers:

• Expanding the geographic coverage of Round Two of the national competitive bidding program for DMEPOS to include 21 more competitive bidding areas.

• Eliminating the first-month purchase option for standard power wheelchairs (complex rehab power mobility devices would retain the option).

• Applying NCB prices nationwide to all HME suppliers by 2016.

• Removing the 2-percent fee schedule increase for DME categories covered in the bidding. This increase was promised to providers per MIPPA in exchange for the delay to implementing Round One.

• Requiring mandatory face-to-face evaluations for all HME claims.

• A productivity adjustment to the HME fee schedule that will annually lower payments by 1 to 1.5 percent.

• An excise tax on manufacturers of DME.

After the late-night vote concluded, President Obama addressed the public from the White House, joined by Vice President Joe Biden.

"Long after the debate fades away, and the prognostication fades away, and the dust settles, what won't remain standing is not the government-run system some feared, or the status quo that serves the interests of the insurance industry, but a health-care system that incorporates ideas from both parties; a system that works better for the American people," President Obama said in the national address. "... This legislation will not fix everything that ails our health-care system, but it moves us decisively in the right direction. This is what change looks like.

"It's time to bring this debate to a close, and begin the hard work of implementing this reform properly on behalf of the American people," he continued. "Tonight we answered the call of history as so many generations have before us. When faced with crisis we did not shrink from our challenge; we overcame it. We did not avoid our responsible; we embraced it. We did not fear our future; we shaped it."

The House congressional caucus, led by House Speaker Nancy Pelosi (D-Calif.), also made an address after the vote.

"[The vote] honored the vows of our founders to be a land of opportunity all the way back to before we were a country in the Declaration of Independence, talking about 'life, liberty and the pursuit of happiness.'" Pelosi said. "That defines opportunity, so to did this bill tonight."

While the President, Vice President and House Democratic leadership took their victory lap, the HME industry was anything but celebratory given the provisions in the bill affecting the industry.

"For DME suppliers, there is little to be happy about in the historic health-care reform bills," said Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers. "The expansion of competitive bidding to 100 areas and the application of bid rates to all areas by 2016 will have the broadest impact and makes repeal through HR 3790 even more critical. In the short-term, the excise tax on medical devices will add cost for suppliers while the loss of the projected 2 percent increase and the productivity adjustments will reduce fees, making a double hit to suppliers."

"This is not a very good bill for the HME industry or our patients," said John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers. "It extends and accelerates the implementation of suicide bidding; there is an anticipated $500 billion in Medicare cuts; and the elimination of the first-month purchase option for power wheelchairs will result in a tremendous financial burden to providers. And while reimbursements are being cut left and right, the measure will increase costs due to the new 'wheelchair tax' on device manufacturers. This is a bad day for HME. This is a bad day for Medicare beneficiaries. The elderly and the disabled have clearly been identified as low priorities in this new health-care equation."

Going forward the DME industry must increase efforts to repeal competitive bidding by pushing for cosponsors to H.R. 3790, the bill introduced by Rep. Kendrick Meek (D.-Fla.) that calls for the repeal of the Centers for Medicare & Medicaid Services’ national competitive bidding program, Stanfield said.

"There is little else that can be done in the short-term," he explained. "Making changes to the other harmful provisions will require the industry to pay for them by offsets and the industry cannot give up any more and remain viable."

About the Author

David Kopf is the Editor of HME Business.

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