Richard W. Henderson, MD
Legislatively, there’s a lot at stake for ob-gyns. In this report, I will briefly focus on the effect of the Budget Control Act of 2011, or sequestration, on the sustainable growth rate (SGR); graduate medical education (GME) and discretionary health funding; reproductive health; medical liability reform; the Independent Payment Advisory Board (IPAB); and Medicaid. Sequestration became effective on March 1 because compromise in our political system could not be reached to prevent it.
Under the current SGR formula, Congress has temporarily diverted two major cuts to Medicare that would have had a significant negative influence on medicine. The first was a 27% cut to physician’s payments, and the second was an across-the-board 2% cut in Medicare payments to hospitals. These cuts remain on the table unless they are again diverted by Congress. ACOG supports and has been working for repeal of SGR as part of meaningful deficit reduction efforts. For the first time in many years, there is a sense of optimism this could occur.
GME funding is at significant risk because Medicare contributes $9.5 billion a year to the training of medical residents and is the single largest contributor to that training. The 2% cut to Medicare under sequestration would severely exacerbate the workforce issues created by the cap on Medicare-supported residency slots that has been in place since 1997. The effect on ob-gyn training programs would further worsen the existing shortage in our specialty. For this reason, ACOG supports and has been working to encourage Congress to support GME funding.
Discretionary health funding is critical to maintain medical research, preventive care, and family planning programs along with other programs for women’s health. Under sequestration, this funding would be cut by 8% over the next 10 years for all health agencies. ACOG supports this funding and has been working to prevent the proposed cuts in this funding.
Under sequestration, federal funding for reproductive health and family planning would also be cut. ACOG views these services, along with contraceptive access, as important components to help give women most at risk the freedom of self-determination regarding their reproductive futures. ACOG supports these services and has been working to oppose these cuts as well.
Meaningful medical liability reform remains a priority for ACOG, which continues to support and work to make it part of true deficit reduction plans.
The IPAB was created as part of the Affordable Care Act as a government board charged with the sole responsibility of cutting Medicare spending. It will be implemented in 2014, is composed of 15 appointed members, the majority of which cannot be practicing physicians, and would have little congressional oversight. Hospitals, nursing homes, and other providers (but not physicians) would be exempt from IPAB cuts for the first five years. ACOG supports and has been working for the repeal of the IPAB.
Medicaid provides services for more than 21 million women and covers more than 41% of all births in the US. More than two-thirds of its beneficiaries are women. Pregnant women, children, and non-disabled parents make up 76% of the Medicaid population but account for only 32% of Medicaid spending. ACOG opposes block grants that would shift the cost to the states because of cuts to eligibility benefits for patients and provider payments that would follow. Such cuts would harm ob-gyns’ ability to care for and treat low-income women. ACOG supports and has been working to protect Medicaid to care for low-income pregnant women. Read more about ACOG’s 2013 legislative priorities.
The majority of organized medicine is focused on and galvanized around the issues outlined in this report. However, only ACOG and its federal political action committee, Ob-GynPAC, speak for women’s health care issues and our specialty. The PAC has increased both ACOG’s visibility and influence on Capitol Hill, but there is much more that must be done.
As of December, only 5% of the 41,000 ACOG members eligible to contribute did so. The average contribution was $200, allowing the PAC to raise and distribute $1,013,607 during the last election cycle. In District III, 7% of our members (306 of 4,300) have contributed to the PAC. Thank you again to those who have and continue to contribute. For those who have not, it’s time to step up. There is a lot at stake if we fail to do so. (You will not be favored or disadvantaged by reason of the amount of your contribution or a decision not to contribute. Contributions from foreign nationals are not permitted.)