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Commentary |
1 Diagnostic Radiology, Yale University, 333 Cedar St., New Haven, CT 06510-3206.
The opinions expressed in this commentary are those of Howard P. Forman;
they do not necessarily reflect the viewpoint or position of the editors,
reviewers, or publisher of the American Journal of Roentgenology.
Readers are encouraged to submit letters to the editor in response to this
commentary.
Keywords: Congress • diagnostic radiology • Medicare
With a new Congress, a Democratic majority in the House and the Senate, and a truly open field for both the Republican and the Democratic Party presidential nominees, the political scene is uncertain. Uncertainty can mean turmoil, especially as it relates to health care where the political stakes are high. In this brief, I would like to focus on the current Congress and some of the issues that are likely to be considered.
It is instructive to start by knowing the new elected leaders of the committees of jurisdiction. I would argue that each of us has a responsibility to educate our elected representatives about our role in the health care delivery system. More to the point, if you believe that congressional action (or inaction) might reduce or halt access to necessary imaging services, you should speak to your elected officials. If your elected official is on a committee of jurisdiction, you will find a more willing ear because while professional lobbying and advocacy are highly effective, individuals (read "YOU") elect our representatives. Individuals remain the root of our democracy.
As was mentioned in a previous brief, there are four health-care-related committees in Congress. In the House of Representatives, the House Ways and Means Committee, Subcommittee on Health has jurisdiction over the Medicare program. This committee is now chaired by Representative Fortney "Pete" Stark, whose name is best known to most of you as the author of the eponymous "Stark" referral laws. Representative Stark is a seasoned veteran of the committee and has a broad understanding of the Medicare program. The ranking member of the committee, Dave Camp, is also a seasoned Congressional veteran, but with little past experience in health care, replacing the very powerful Nancy Johnson (and previously Bill Thomas, who chaired the full committee in the waning days of this past Congress). (See below for a full list of the subcommittee members.)
The House Energy and Commerce Committee, Subcommittee on Health, is the other main health care committee, with jurisdiction over most of the remainder of health and health care services, including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Medicaid program, and the State Children's Health Insurance Program (SCHIP). Here, Congressman Frank Pallone of New Jersey is the chair, with Congressman Nathan Deal of Georgia as the ranking member. This committee will be much in the limelight this year, with the important reauthorization of the SCHIP program on the docket. (See below for a full list of the subcommittee members.)
In the Senate, the full committees (rather than the subcommittees) are most important in the health care legislation process. The committee with jurisdiction over the Medicare, Medicaid, and SCHIP programs is the Finance Committee, led by two seasoned veterans of health care: Senator Max Baucus of Montana as the chair and Senator Charles Grassley, as the ranking member. It is truly a bipartisan partnership and the two members are thoughtful and passionate about health care, access, and fiscal responsibility. (See below for a full list of the committee members.)
The committee with jurisdiction over most of the remainder of health care (NIH, CDC, Food and Drug Administration [FDA], etc.) is the Health, Education, Labor, and Pensions Committee, chaired by Senator Edward Kennedy of Massachusetts and Michael Enzi (of Wyoming), the ranking member. Through their responsibility for the FDA, this committee actually does have considerable sway on issues related to imaging. (See below for a full list of the committee members. It is interesting to note that two of the committee members—Hillary Rodham Clinton and Barack Obama—are presidential hopefuls.)
There are many issues regarding the Medicare program that will require adjustment and legislative consideration in the next year. I will address these in a subsequent brief, when I talk about the current status of the Medicare program. But there are many other issues that are also of concern and it is important to be aware of these, too. In most of these instances, their direct impact on radiology is small, but they will affect each of us, either personally or as a trickle down effect through the health care system and health care economy.
Perhaps the most important health care issue to come before the Congress this year is the reauthorization of the State Children's Health Insurance Program (SCHIP), which has been a huge success and a great example of the ability for both parties to work together toward a common important goal: in this case, children's access to health care services. This act, passed in 1997, has insured millions of poor children in state-based health care programs, costing less than the Medicaid program alternative, and causing very little "crowd-out," the phenomena of public insurance merely replacing private insurance, rather than insuring the previously uninsured. This program will be reauthorized, but there are many necessary changes that are contentious and will attract increasing attention as we approach the program's scheduled expiration in September.
Another key piece of legislation that is being considered in both houses is "Mental Health Parity," an area of concern to both the employer-based health care system and the Medicare Program. Currently, mental health care issues are generally treated quite differently from "physical" health care issues, and parity has been a major bipartisan effort for many years. Many commentators have raised concerns that this might lead to higher health care costs without comparable improvements in care, but others will argue that this can be managed as with other biological processes [1].
While further legislation during this session is unlikely, the issue of the uninsured will be very visible, through committee hearings and political discourse. This issue, most clearly, has an impact on our practices and our lives, but is unlikely to be readily addressed (other than some additional coverage through the SCHIP program, as above), by the federal government during any time before the next election. On the other hand, state-based legislation, notably in California and Massachusetts, holds great promise and will be worth watching, as implementation begins.
The NIH budget also has been of great concern to the global health care community, with no less significance to our practices. The future of our health, research agenda, and health care delivery depends on our national investment in research. Both the NIH and the Agency for Healthcare Research and Quality (AHRQ) require appropriate funding to fulfill their mandate and our needs for better information to improve health and health care.
This brief is not nearly a consummate representation of the health care legislative agenda, but I do believe it gives the reader a blueprint for the next year. The next 16 months, leading up to the Presidential election of 2008, will be a vigorous time of debate over many health care issues, all of which affect us in one way or another. Understanding the present legislative priorities can afford the reader the wherewithal to better communicate with our representatives and help improve health care delivery to the nation.
In future briefs, I will again describe the specific issues affecting the Medicare program and why I believe we, as radiologists, still have much to be concerned about.
House Ways and Means Committee, Subcommittee on Health
House Energy and Commerce Committee, Subcommittee on Health
Senate Finance Committee
Health, Education, Labor, and Pensions Committee
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