Posted by: Crystal | November 10, 2009

House Passes New Health Reform Legislation


Matt Willette updates us in a letter titled U.S. House Narrowly Approves Sweeping Health Reform Legislation addressed to the member of the Facebook group America’s Vision, Optometry’s Future.

Following a rare weekend session, the House approved sweeping health reform legislation (H.R. 3962) late Saturday night by a vote of 220 to 215.

The massive bill included the AOA-backed provisions referenced in Dr. Brooks’ and Dr. Ellis’ update to all AOA members sent last week ( )

– Including the Ross amendment (non-preemption of state provider non-discrim laws), children’s vision as an essential benefit, the Schakowsky amendment (Medicaid physician status for ODs) and an extension of the Medicare surety bond exemption for eyeglasses. –

Thirty-nine Democrats opposed the bill. One Republican voted yes. Rep. Joseph Cao (R-LA) represents a largely Democratic district, once represented by recently convicted Democrat William Jefferson.

The bill would require most individuals to buy health insurance if they don’t get it through their jobs, beginning in 2013. Families with incomes up to 400 percent of the federal poverty level could qualify for financial assistance. Employers with annual payrolls over $500,000 would be required to provide coverage or contribute to a fund for such coverage.

It would also create an “exchange” in each state where individuals and certain small businesses could shop for insurance policies, and it would create a public insurance plan to compete with offerings from private companies. Also…

-Insurance companies could no longer refuse to cover customers with pre-existing medical conditions, impose annual or lifetime benefit limits or cancel a policy when someone files expensive claims.

-The measure also would expand eligibility for Medicaid to individuals and families with incomes up to 150 percent of the poverty level.

-Payments under the Medicare Advantage program would be reduced and the Medicare prescription drug program would be enhanced by phasing out a coverage gap.

-The bill would impose a tax surcharge of 5.4 percent on couples with gross incomes of more than $1 million and individuals with incomes of more than $500,000, and a 2.5 percent excise tax on the sale or lease of medical devices.

The Congressional Budget Office (CBO) estimates that the gross cost of the bill would be almost $1.1 trillion through fiscal 2019, but the net cost, after taxes, fees and penalties are taken into account, would be $894 billion. As a result of tax provisions and spending reductions in the bill, it would actually reduce the deficit by $104 billion, CBO estimates.

Early Saturday morning, Democratic leaders struggled to secure the 218 votes needed for passage. Federal funding of abortion services was a major sticking point. To help clear the way for the bill’s adoption, House leaders agreed to allow Rep. Bart Stupak (D-MI) to offer an amendment to H.R. 3962 that would add, and in the view of some, strengthen, existing prohibitions on federal funding for abortion.

Private insurers selling plans through the new health insurance exchange could not offer policies covering elective abortions to people who receive federal subsidies for their premiums. The so-called “public option” included in the bill would face the same restrictions. The Stupak amendment was adopted by a vote of 240 to 194. Rep. John Shadegg (R-AZ) voted present. Sixty-four Democrats joined with 176 Republicans in voting for the amendment.

Earlier Saturday, President Obama traveled to Capitol Hill to meet with the House Democratic Caucus. Obama told Democrats: “We have to continue moving forward,” to enact health reform legislation. “Here it is. Here is a moment to make history. That’s why we’re here,” he said.

Republicans offered an alternative health reform plan in the form of a substitute amendment. This substitute would take incremental steps to increase health coverage by limiting medical malpractice lawsuits, expanding the use of tax-sheltered medical savings accounts, and allowing insurance to be sold across state lines.

The Congressional Budget Office calculated that the Republican plan would cost about $61 billion over 10 years and result in coverage for 83 percent of the population. The substitute was defeated by a vote of 258 to 176. Rep. Tim Johnson (R-IL) was the lone Republican to oppose the GOP’s health reform alternative.

Earlier in the day, the House voted 242 to 192 to approve the rule providing the framework for debate of H.R. 3962. Fifteen Democrats voted with all Republicans against the rule. The rule also set up an upcoming debate on a bill (H.R. 3961) to change the way Medicare reimburses physicians.

The bill (H.R. 3961) would block a 21 percent reduction in the Medicare payment rates for physician services scheduled for January 2010 and would restructure the formulas setting payment rates on a long-term basis. The rule for floor debate, which could start the week of Nov. 16, would be closed, meaning no amendments are in order. It also would provide that upon engrossment of the bill, the text of another measure (H.R. 2920), a pay-as-you-go budget rule requiring new mandatory spending or tax cuts to be offset, would be added to it.

The focus now turns exclusively to the Senate, where moderate Democrats, and Republican Senator Olympia Snowe (ME) carry even greater weight to conform a final product to their satisfaction.

Now is the time to do more than ever before in support of AOA-PAC ( ) and the AOA Federal Keyperson program (, and to make a difference at this critical moment. 

This will have a dramatic effect on the face of healthcare as we know it. We welcome any comments or discussion on this topic.


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  1. I think the existing conditions clause is an excellent idea! I feel this legislation is a step in the right direction, but more has to be done! I personally would like to see the insurance companies REQUIRED to contract practicing medical doctors with good records so that when a doctor feels a patient needs a prescription or procedure, an insurance company doctor reviews the case to give or turn down pre-authorization INSTEAD of someone that might have a business degree being responsible for it. In this way, the patient would have the comfort of a sort of 2nd opinion as well.

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