ACOG's Health Reform News

ACOG's Health Reform News
The Recess Report
August 14, 2009

What Have We Accomplished So Far?

ACOG won many elements of our Health Care for Women, Health Care for All campaign in H.R. 3200, the House health reform bill and the Senate HELP Committee plan:

  • Physician Payment: The House bill repeals Medicare's flawed Sustainable Growth Rate (SGR) payment formula, an enormously important win for all physicians and patients. Instead of a 20.1% cut, in 2010 ob-gyns would have a 0.4% payment increase, estimated to rise to 3.8% over the next five years. Pours $245 billion back into physician payments.
  • No Ultrasound Cuts.
  • Guaranteed Maternity Coverage: The House TriCommittee bill and the HELP bill guarantee maternity coverage in virtually all plans. Senate Finance is likely to follow suit. The HELP Committee included young adult plans that would not have to abide by the same coverage requirements. Historically, young adult plans exclude maternity coverage and many also exclude prescription drug coverage.
    • ACOG is working to ensure that all women have access to maternity coverage.
  • A Woman's Medical Home: ACOG won a woman's medical home and inclusion of ob-gyns in 2, and probably all 3 plans. This would make federal funds available to qualifying practices to participate in a medical home demonstration project.
  • Ending Preexisting Condition Exclusions: All 3 bills will prohibit insurers from denying or limiting coverage for pre-existing health conditions.
  • Ending Gender Rating: All 3 bills will prohibit insurers from charging individuals higher premiums based on gender and health status.
  • The House bill gives ob-gyns, whose Medicare E&M charges make up over 50% of their Medicare billable charges, a 5% bonus on their Medicare payments.
  • Ob-gyns who qualify for the 5% bonus will get an additional 5% if they practice in rural areas.
  • The House bill includes a public plan and individual and employer mandates.
  • Medicaid:
    • Payments: In the House bill primary care services would achieve parity with Medicare rates over a 3 year period.
    • State option to expand coverage of family planning services.
    • Ensuring that Medicaid-eligible individuals seeking coverage in the Exchange be eligible for full Medicaid wrap-around services.
    • Ensuring State Maintenance of Efforts for Medicaid.
    • Coverage of smoking cessation counseling for pregnant women.
  • Physician Participation in the Public Plan:
    • In the House bill, a physician who takes Medicare could opt out of the public plan. Some physician groups have asked for an opt-in instead.
    • In the House bill, public plan rates may be negotiated with physicians, rather than based on Medicare rates.
  • No cost-sharing for Preventive Services. ACOG is working to ensure that all well-woman services are considered preventive services.
  • The bill establishes a Comparative Effectiveness Research Commission. This provision includes language requiring the Commission to consult with stakeholders including physicians and that research must take into account differences based on subpopulations, including women. Rep. Tim Murphy (R-PA) offered an ACOG supported amendment that requires that the work be done in consultation with, and reviewed by, the specialty colleges and academies of medicine to determine best practices within their field of specialty. He specifically referenced ACOG. His amendment was accepted by the Energy and Commerce Committee.
  • ACOG Fellow Rep. Gingrey (R-GA) succeeded in adding language that would prohibit CER findings from being used to make deny coverage for medical treatments, services, or items under Medicare on the basis of cost.
  • The draft of the House bill would have charged the newly established Center for Quality Improvement to focus on improving the provision of obstetrical and neonatal care, specifically through the appropriate use of cesarean sections and the implementation of best practices for labor and delivery care. ACOG was successful in changing the focus to improving the provision of obstetrical and neonatal care, including the identification of interventions effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.
  • ACOG was successful in the House in ensuring a women's health representative on the United States Preventive Services Task Force.
  • Medical Liability Reform (MLR): In the House Energy and Commerce bill, Rep. Bart Gordon (D-TN) won an ACOG amendment that would provide financial incentives to States who enact Certificate of Merit and Early Offer programs. This isn't enough medical liability reform, but it's a start.

ACOG is still fighting for:

  • Meaningful medical liability reform.
  • A women's health representative on any committee or council that may determine basic benefits standards.
  • Ensuring that coverage decisions be made based on the most current evidence-based and evidence-informed clinical guidelines, practice standards and expert opinions of relevant national medical societies.
  • Keeping the GAO out of graduate medical education decisions.
  • Preserving existing residency slots and adding new slots for ob-gyns.
  • Ensuring that the Center for Quality Improvement collaborates and consults with ACOG.

# # #

ACOG Department of Government Affairs
August 2009

Contact:

Government Affairs Staff 
Mailing Address:
PO Box 96920
Washington, DC 20090-6920
Phone (202) 863-2509
Fax (202) 488-3985
govtrel@acog.org

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998