What this year's Medicare battle portends for health care

The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) was a huge victory for ACP and its allies. Enactment shows how effective advocacy can overcome enormous political obstacles, a lesson that will carry over into next year's anticipated battle over health care reform.

Overcoming roadblocks

The powerful health insurance lobby objected to the Act because it reduces excess payments to Medicare Advantage plans, which is Medicare's managed care network, in order to fund improvements in traditional Medicare. President Bush and conservative allies on Capitol Hill ideologically opposed the bill, believing that the answer to Medicare's woes is to enroll more people in private sector plans, even if it means paying the Medicare Advantage plans more than traditional Medicare.

The hyper-politicized environment in Washington was another obstacle. Intense partisanship, combined with Senate filibusters, could easily have spelled gridlock. Successive rounds of voting overcame the roadblocks. Even then, President Bush vetoed the bill, requiring a Congressional override.

Impact on internists

Physician pay. A scheduled 10.6% cut was avoided, and a scheduled 5.4% cut for Jan. 1, 2009 became a 1.1% increase.

Medicare. Payments for office and hospital visits will increase on Jan. 1, the direct result of an ACP-proposed provision.

Patient-centered medical home. The ACP-championed demonstration project will receive $100 million more in federal funding.

Bonus payments. Internists can get a 2% bonus for successfully participating in the Physician Quality Reporting Initiative, and another 2% for using e-prescribing systems.

Geographic adjustments. The Act renewed a payment floor on regional adjustments to the fee schedule in areas with lower practice expenses.

Internists will see an average $5,000 more on their total Medicare allowable charges in 2008 and 2009. Members can calculate their gains online.

There are further benefits. Medicare will pay for preventive services recommended by an expert advisory panel, such as a longer timeframe to give the “Welcome to Medicare” exam, mental health co-pays that will eventually match the 20% for all other covered services, and a lower asset test to qualify for subsidized Medicare Part D coverage.

What it portends

If the relatively modest changes from the Act faced such big political obstacles, imagine the future roadblocks by those who oppose universal coverage on ideological or self-interest grounds—no matter who is in the White House. The good fight over H.R. 6331 shows how ACP and other advocates for health reform will be able to overcome such obstacles.

Effective advocacy starts with credible policies. ACP advocates policies that are not just in our members' interests, but that are designed to improve access and quality for patients. ACP won the fight over H.R. 6331 because we didn't just advocate stopping pay cuts to doctors. We championed reforms to improve coverage, access and quality.

Coalitions are critical. ACP was directly responsible for several key provisions to improve payments for internists' services. But by joining with many other physician organizations, beneficiaries, mental health advocates, retired military officers and others, we had the collective clout and resources to prevail.

Change involves risk. ACP knew that by supporting a bill championed principally by the Democrats, even though our support was based purely on policy, not partisan grounds, we risked backlash from the White House and Republican lawmakers. In the end, though, the huge bipartisan vote for H.R. 6331 showed that the risk was worth taking.

Informed and motivated members are essential. Calls and letters from thousands of ACP members to their Congresspeople were the single most important factors in getting enough votes for H.R. 6331 to become law.

Next year may offer us the best opportunity in generations to achieve lasting health care reform. Good policies, strong coalitions, the willingness to accept risk, and most of all, the activism of ACP members, can overcome opposition.