Health Care And Education Reconciliation Act Of 2010

Floor Speech

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Mr. Speaker, I rise today to express concerns about three outstanding issues in the final health care reform package: an excise tax on high-cost insurance plans which will be implemented in 2018, cuts to home health care, and the formation of an Independent Payment Advisory Board (IPAB).

Since introduction of the America's Affordable Health Choices Act in July of 2009, my colleagues in Congress and I have been working to craft a health insurance reform bill that creates affordable insurance coverage, lowers costs, and improves access to stable health care that is there when you need it. These efforts have been reflected in the Affordable Health Care for America Act, and Senate-passed Patient Protection and Affordable Care Act (H.R. 3590) as modified by the Health Care and Education Reconciliation Act (H.R. 4872).

The final reform package reflects significant progress in terms of limiting the negative impact of an excise tax on high-cost plans on middle class Americans. The 40 percent excise tax on high-cost plans included in the Patient Protection and Affordable Care Act included cost thresholds that were inadequate to account for premium cost factors independent of generosity of benefits, such as age, gender, and region. I authored a letter, with support from 192 of my Democratic colleagues who opposed this proposal. The Health Care and Education Reconciliation Act made significant improvements to the excise tax, such as adopting higher thresholds for age and gender. More importantly, the bill delays the implementation of the tax until 2018, which will allow ample time to better understand its impact--especially in high-cost regions--and mitigate potential negative consequences.

Another deficit mitigation component that I have concerns about in the reform package includes Medicare ``market basket updates'' for home health providers. While the Patient Protection and Affordable Care Act includes more modest cuts than what was included in the House-passed Affordable Health Care for America Act, I remain concerned about the aggregate size of the cuts to home health care providers. Safeguards in H.R. 3590 such as payment adjustment review authority by the Health and Human Services Secretary should be utilized if ``market basket updates'' prove to be unsustainable for home health care providers in the future. H.R. 3590 also includes provisions that guarantee Medicare home health benefits will not be reduced, which further reiterates the obligation of the Secretary to ensure fair reimbursements.

While I supported passing H.R. 3590 as modified by H.R. 4872 to make significant progress in extending and strengthening current health care coverage, I also maintain concerns about the establishment of the IPAB. Over the course of the health care debate, the IPAB--along with the similar proposals of the Independent Medicare Advisory Council, IMAC, Act (H.R. 2718) and the Medicare Payment Advisory Commission, MedPAC--have garnered attention as a mechanism to reduce aggregate health care costs.

However, I believe that the solidification of IPAB would be a move in the wrong direction in terms of broad health care reform. Congress has played an integral role in shaping a Medicare system that reflects unique care needs of varying demographics as well as need differences between regions and states. Further, this system has been developed with transparency and accountability in congressional debates. Redirecting control of Medicare to the Executive branch would limit the strengths of the current system, and would continue a disturbing trend of ceding Congressional authority to the Executive branch.

That is why I cosigned letters in July and December 2009 opposing the establishment of a Payment Advisory Commission. While I did not support the inclusion of IPAB in the H.R. 3590, I am reassured that the bill does not empower the Board to override Medicare laws. Going forward, I urge that the IPAB conducts business transparently, with public input. I also urge that the Board reach out to all Medicare stakeholders and take seriously the role of the Consumer Advisory Council in the future.

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