Statement On: Affordable Health Care For America Act
Madam Speaker, I rise today to express my support for the Affordable Health Care for America Act. Today marks an historic day for the health of all Americans. Today, this Congress joins with the American people to say that health care is…
Madam Speaker, I rise today to express my support for the Affordable Health Care for America Act. Today marks an historic day for the health of all Americans. Today, this Congress joins with the American people to say that health care is not only a policy issue, but an issue of morality; and no longer will the conscience of this country allow Americans to go without access to affordable, comprehensive health care coverage. I want to thank Speaker Pelosi and the House leadership for their steadfast determination; and Chairmen Rangel, Miller, and particularly Chairman Waxman of the Energy and Commerce committee on which I am proud to sit, for their thoughtful leadership on this issue.
Access to affordable health care has the power to break the shackles imposed on Americans today who are fearful of leaving their job, starting a new business, or going to the doctor due to their lack of coverage. In my district alone, this bill has the power to provide coverage for 30,000 uninsured residents; improve employer-coverage for 524,000 residents; provide credits to help pay for coverage for up to 120,000 households; improve Medicare for 84,000 beneficiaries, including closing the prescription drug donut hole for 7,400 seniors; allow 20,000 small businesses to obtain affordable health care coverage and provide tax credits to help reduce health insurance costs for up to 18,600 small businesses. Additionally, this legislation will protect up to 1,100 families from bankruptcy due to unaffordable health care costs; and reduce the cost of uncompensated care for hospitals and health care providers by $28 million.
As a member of the Energy and Commerce committee I was able to fight to include several provisions that will improve access to affordable health care in Washington state, the most important of which is President Obama's public health insurance option. Like our President, I believe that it is important to protect the interest of the consumer by providing choices so that people may decide which health insurance solution works best for them and their family. That is one reason I am a strong advocate of a public health insurance option. The President's public health insurance option will be offered in a health insurance exchange, created in this bill, alongside coverage sold by private insurers; thereby using natural market competition to control the rising cost of health coverage while protecting consumer choice. The implementation of this exchange will make insurance affordable for an additional 36 million Americans, raising the share of legal, nonelderly residents with health insurance coverage from 83 percent to 96 percent. The public insurance option will bring competition to the marketplace and consumer interests will be protected by addressing affordability and access issues that plague our current system.
Washington state is a leader in high-quality, efficient health care. Our doctors and hospitals produce some of the country's best health care outcomes. We have a culture of medicine that places emphasis on patient safety, outcomes, and care. And yet for decades we have been penalized for our efficiency by receiving lower reimbursement rates per service under the Medicare fee-for-service reimbursement model. On average our providers are reimbursed fifteen to fifty percent less per service than their counterparts in other parts of the country. The reason for this discrepancy is that our statewide efficiency gives the appearance that it merely costs less to deliver care in the state because our overall patient costs are lower.
Opponents have argued that practice expenses vary by geography. But, on November 5, 2009, the American Medical Association (AMA) released the results of its 2007-2008 study that included physician practice expense information from over seventy medical specialty societies and the Centers for Medicare and Medicaid Services Physician Practice Information (PPI) survey. The results of the study showed that expenses did not differ significantly by either metro location or census region and reconfirmed what providers in Washington state have know for decades--that the Medicare physician payment formula is flawed.
To this end, I was honored to be one of eight Members chosen by Speaker Pelosi to negotiate a resolution to this geographic disparity issue that has plagued our country for decades. The result, after four months of negotiations, is an agreement that will move the nation to a system that rewards high quality, cost-effective care; reimbursing for the value rather than the volume of services. It will fix existing Medicare geographic payment inequities and will cover both physician and hospital payments. This will provide an historic transformation of the Medicare payment system to ensure better care for patients and reduce health care costs over the long term.
The first part of the agreement addresses the geographic variation in the rates doctors are paid per service. The bill instructs the Institute of Medicine (IOM) to conduct a study to evaluate and make recommendations to improve the geographic adjustment factors in the Medicare reimbursement formulas which will be completed one year after enactment. The Secretary of HHS will then implement a new Medicare payment rate that takes into account the IOM recommendations. An initial investment of $4 billion per year in 2012 and 2013 is allocated to make payment rate adjustments. After 2013 reimbursement adjustments will become budget neutral.
Geographic variation in the utilization of services is addressed in the second IOM study on high value care. The IOM will make recommendations on how to transform the Medicare payment system to reward value and quality of care. Value is defined as the efficient delivery of high quality, evidence-based, patient-centered care. The study will be completed by April 15, 2011. No later than ninety days after the report is completed, the Secretary of HHS will submit to Congress a preliminary implementation plan based on the IOM study, which MedPac and GAO will evaluate within forty-five days. The IOM's quality and value-based payment recommendations will automatically go into effect unless the House and Senate pass joint resolutions of disapproval by May 31, 2012. The goal was to finish all studies and changes before the public option goes into effect in 2013 so the recommendations would be incorporated.
This deal is a real victory for Washington state. Correcting the fundamental inequalities in Medicare reimbursement rates that underpay Washington state physicians will ensure access to Medicare physicians for Washington state seniors and Medicare beneficiaries. Additionally, this provision sets in motion a fundamental shift in the way we will reimburse for medical care going forward; moving away from a fee-for- service model and towards an outcome-based model. This shift will provide real cost containment by incentivizing and reimbursing for the quality, not the quantity, of medical care across the United States; saving the country billions of dollars.
A compounded issue resulting from Medicare reimbursement disparity is the reliance on Medicare Advantage plans by Medicare beneficiaries in low cost areas. Medicare Advantage plans in Washington state have played a critical role in providing seniors with access to care because they have been able to reimburse providers at a higher rate than traditional Medicare, thereby attracting providers into the network who would otherwise be unable to treat Medicare beneficiaries due to cost. It is for this reason that I fought tirelessly to ensure a quality bonus for high-quality, efficient Medicare Advantage plans. Under the language I negotiated in the House bill, four-star rated plans and above, in the bottom thirty percent of costs to the system, would be eligible for a 1.5 percent bonus in 2011; a 3.0 percent bonus in 2012; and a 5.0 percent bonus for each subsequent year. These bonus payments will ensure the continuation of high quality health care for Medicare Advantage recipients in Washington state.
Washington state is not only a leader in patient care, but also in medical innovation. The biotech industry is an important health care partner in Washington state. Across the state roughly 1,060 biotech companies employ 23,047 Washingtonians. The state ranks eighth in National Institute of Health grants and in the past two years academic bioscience research expenditures totaled $685 million. The innovation occurring in the state has lead to some of the leading biologic therapies for life-threatening illnesses such as cancer, multiple sclerosis, diabetes, HIV/AIDS and many serious rare diseases.
Biologics are living organisms, different and more complex than small molecule drugs. Biotech medicines can be determined to be the ``same'' as the original drug, but science is not yet at a point where they can be determined to be ``identical.'' And even small differences between a copy and an original biologic can cause differences in effectiveness, and, in some cases, serious side effects. Therefore it is necessary that policy reflect the uniqueness of these therapies, and ensure drug efficacy and patient safety. I believe a pathway for the approval of biosimilar biologics is the critical next step to providing patients with increased access to lifesaving therapies. I also believe that we can create a pathway that provides patients with lower-cost medicine without sacrificing safety or eliminating incentives to create breakthrough medicines.
This is why I, joined by my fellow committee members Anna Eshoo and Joe Barton, introduced H.R. 1548, the Pathway for Biosimilars Act. The legislation protects patients by ensuring patient safety, recognizing the scientific differences between small-molecule drugs and biologics, maintaining the physician-patient relationship, and preserving incentives for innovation. I was proud to co-sponsor an amendment in the Energy and Commerce Committee markup of H.R. 3200 that incorporated key pieces of our legislation. The amendment includes twelve years of data exclusivity for innovator biologics, ensuring not only that these life-changing and life-saving biologic treatments are more accessible and affordable, but that we also foster continued research and development investment needed to search for new cures and treatments. The strong bipartisan votes in both the House and Senate on this issue demonstrate that Congress is committed to a fair and safe pathway for biosimilars. I commend the House for adopting my legislation as part of HR 3962, and it is my sincere hope that it will be included in the final conference agreement.
A few other provisions that I want to highlight are great examples of how Washington state's health care leadership has helped shape federal health care legislation. Earlier this year the state passed a common sense law that will save billions of dollars in administrative health care costs by standardizing insurance claims and forms processes, and I was proud to fight for the inclusion of similar language in the Affordable Health Care for America Act. Washington state has also been innovative in health care plan structures allowing for the emergence of direct primary care medical home plans that provide low cost coverage of primary care services. This model has granted access to care for a population that has been shut out from traditional health care coverage due to high costs. I was grateful to see the inclusion of this coverage model in the health care reform legislation. I am proud to represent a district and state that is leading the way on health care policy.
Once again I would like thank Speaker Pelosi and the House leadership for their continued determination that brought all facets of the Democratic Caucus to the table and ensured that each member had a voice in the debate. As a result the House of Representatives has produced a health care reform bill that will provide access to affordable health care and bend the cost curve; and I am once again proud to offer my support.