America's Healthy Future Act of 2009 

This proposal is largely the result of a bipartisan effort by six members of the Committee, now known as the "Gang of Six."  But the three Republican members of the group, including Senator Grassley, say they do not support the bill in its present form.  Senator Grassley has indicated he will continue working with Baucus and the other four members, but he believes key policy differences remain.

AHFA's current version would require most Americans to have health insurance.  However, it does not include the more controversial, and much debated, "public option."  The bill does include a number of provisions aimed at ensuring affordable, quality coverage and improving the efficiency of the health care system.  It would create tax credits to help low and middle income families purchase insurance in the private market and would prohibit insurers from denying coverage based on pre-existing conditions and health status.  The bill would also standardize Medicaid coverage for everyone under 133 percent of the federal poverty level.  Health care providers would be encouraged, through financial incentives, to adopt cost-effective health technology, like electronic medical records.  And, out-of-pocket costs for screening and prevention services for Medicare beneficiaries would be eliminated.

The proposal does not include some of the key changes called for by the Republican members of the Gang of Six.  For instance, earlier this week, the Republican members had requested that the federal government pay 100% of the Medicaid expansion to avoid an "unfunded mandate" for states, which otherwise share in Medicaid costs.  The proposal, however, would continue state funding with percentage-based federal financial assistance.  The proposal also includes annual fees for health insurance companies, a feature introduced by Chairman Baucus, but opposed by Republican Senators Enzi and Grassley.  The fees are designed to help finance coverage for uninsured individuals.

Other features of the proposal have already received some attention at the federal level, as key legislative or health policy changes, such as Medicare hospital and physician value-based purchasing; redistribution of unused residency slots to primary care training programs; prohibiting physician referrals for Medicare services to hospitals with physician ownership; and mandating community health needs assessment and financial assistance policies for Section 501(c)(3) hospitals.  A draft of AHFA can be found here: 
http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

President Obama is on the Offense

On September 9th, President Obama gave a speech to Congress that outlined what he considers to be the material aspects of health reform, including creation of some type of public insurance option.  In his speech, the President also rebutted criticisms of health reform that have intensified as of late and tried to reestablish the urgency of reform.  It remains unclear how the President's proposals for health reform will be reconciled with the major health reform bills currently on the table and, to make matters more interesting, there has been some talk of the White House releasing its own health reform bill in the near future.  A copy of President Obama's speech can be found here:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/. 

To Cap or Not to Cap 

One particularly contentious provision in the current version of AHFA is a place marker for potential malpractice reform.  Although currently limited to a suggestion that state demonstration programs be established to evaluate alternatives to our current civil litigation system, any final product making its way out of the Senate Finance Committee that goes beyond funding of a demonstration project may become problematic.  Democrats and Republicans are at odds on the need for malpractice reform and with Senate Judiciary Committee jurisdiction malpractice reform could be yet another stumbling block to reform.

So Where do Doctors Stand? 

The results of two recently published surveys in the New England Journal of Medicine indicate that a large majority of physicians who were polled support some form of a public option for health insurance.  This is an interesting result given the way most physicians are perceived to view their current relationship with Medicare and Medicaid.  And these poll results also seem to run contrary to the American Medical Association's opposition to a public option.  Links to these surveys can be found here:
http://healthcarereform.nejm.org/?p=1790&query=home and http://healthcarereform.nejm.org/?p=1785&query=home