December 4, 2009 - Advocacy Corner

Senate Debate Begins on Health Reform. Earlier this week the Senate kicked-off debate on overhaul legislation likely to last until Christmas or longer. The 60 votes that paved the way for consideration of the bill initially may prove more elusive for action on the final bill. Issues of the public option and language on abortion coverage remain major hurdles. On the former issue, Majority Leader Reid (D-NV) is working with moderates Sens. Mary Landrieu (D-LA), Joseph Lieberman (I-CT), Blanche Lincoln (AR) and Ben Nelson (D-NE) on a compromise. Options include a "trigger" that would enact a public plan in states where insurers fail to provide adequate and affordable coverage. A second option is an “opt-in” clause as opposed to automatically including a State unless it “opted-out.” Beyond strategy on substantive issues, Reid is focusing on parliamentary tactics, such as allowing Republicans time to offer their concerns and revisions on the bill, while at the same time assuring they do not slow momentum on debate by introducing large amendments or insisting on a full reading of every proposal offered.

Cost continues as a central topic of concern. The Congressional Budget Office (CBO) estimates a ten-year cost of $848 billion. During this time, the plan is expected to reduce the deficit by less than 2 percent, which does not support the Democrat’s assertion of dramatically reducing the federal deficit.

White House officials meanwhile are continuing to build public support for health reform legislation by pointing to health IT provisions as central to the proposal’s cost containment strategy. OMB Director Peter Orszag and White House Health Reform Director Nancy-Ann DeParle indicated that establishment of a Medicare Commission will continually implement proposals to improve quality. They also pointed to funding for research to establish evidence-based care. These provisions, however, lack real teeth in that reimbursement is not tied to use of evidence-based medicine nor does the Medicare Commission have powers to make major reimbursement changes.

House and Senate leaders would like to wrap up a “holiday package” for the President by passing the Senate bill, convening a conference committee and delivering this New Year’s gift in time for a bill-signing before his State of the Union speech in January. Outcome of this holiday wish is still very much up in the air.

ONC Outlines New Office Structure. As the Office of the National Coordinator (ONC) continues to assume increased responsibility for implementation of the HITECH Act, it is undergoing major transformation. Originally established by Executive Order as a small policy office in the Office of the Secretary, ONC is now tasked with grant-making, policy-development and issuing regulations, to name just a few functions. To accomplish these missions, ONC is recruiting numerous individuals from private sector organizations long active in the health IT field. Details as to who is filling particular slots are not yet available, pending release of an organization chart. Availability of such a chart would do much to assist the IT community to communicate with ONC staff during this critical implementation phase. According to the announcement, five new offices were created under the reorganization:

• Office of the Deputy National Coordinator for Programs and Policy will oversee programs designed to promote interoperability, information exchange and "meaningful use" of health IT; ONC's programs and coordination division formerly handled this function;
• Office of the Deputy National Coordinator for Operations includes such tasks as administrative functions, budget formulation, contract management and financial planning; ONC's policy and research group handled this previously;
• Office of the Chief Privacy Officer, a new Federal function, reflects the priority that patient privacy presents for EHRs and its ongoing attention by Congress, privacy advocates, providers and the industry as whole;
• Office of Economic Modeling and Analysis gives ONC much needed in-house statistical and economic expertise to analyze health IT investments and policies; this office replaces ONC's health IT adoption division; and
• Office of the Chief Scientist charged with evaluating and tracking health IT grant and research program, replaces ONC's interoperability and standards group.