I can always tell when someone is a doctor - all I do is make sure they're wearing a white lab coat and a stethoscope. Senate Democrats, including Sen. Charles Schumer (D-N.Y.) at right, surrounded themselves with white-coated, stethoscope-wearing persons when unveiling the merged Senate health reform bill Nov. 19.
That bill has now advanced, as predicted. The Senate voted to begin debate on the health reform bill in a party-line vote Saturday. While Democrats cleared yet another obstacle on the way to passing the legislation, they've got dissension in the ranks: Sens. Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.) have explicitly come out and said they won't vote for a final bill that includes a government-run insurance plan open to the public.
Landrieu and Lincoln did vote to bring the merged Senate bill - which includes the public plan - to the floor for debate, because the alternative would've allowed a Republican filibuster and the reading of long documents and the accompanying gnashing of teeth.
But we're just getting started. You can expect debate over the Senate bill to begin in earnest after the Thanksgiving break. The debate will include the introduction of various amendments to the bill, at the end of which the Senate will vote once more on a final version of their bill. Then the final Senate bill must be reconciled with the final House bill (which is ready to go) by a conference committee, and then the resulting bill goes up for a vote in both chambers. And then the president gets a bill on his desk to sign.
Here's a few relevant details on the merged Senate bill (by "merged" I mean it combines bills from the assorted Senate committees).
- It will eliminate the 21.2% physician pay cut and increase payments by 0.5% instead.
- The floor on the geographic price cost index (GPCI) will be extended to increase provider payments in rural areas.
- Medicare Advantage (MA) payments will be rebased on the average of the bids submitted by insurance plans in each market, a move aimed at reducing the cost of MA plans
- The Physician Quality Reporting Initiative (PQRI) gets extended through 2014, and the financial incentives along with it
- A CMS "innovation center" will be created to "develop, test and expand innovative payment delivery arrangements" such as bundled payments and medical homes.
- A value-based purchasing program targeting hospitals will launch in 2013, linking payments to outcomes for conditions like community acquired pneumonia.
Remember: This is the merged, $849 billion Senate bill, not the merged $1.2 trillion House bill. This bill does not permanently address the pay cuts scheduled under the Sustainable Grow Rate (SGR) formula.