On Wednesday, the Senate Finance Committee voted 23 to 0 to accept an amendment submitted by Senator Chuck Grassley, R-Iowa, to adjust what Medicare pays doctors for practice costs in rural states. The Grassley amendment requires the federal government to improve the accuracy of the data it uses to factor in physicians' practice costs in determining Medicare payments. Now, the government uses an outdated formula that uses proxies instead of actual costs.
Under the current formula, employee wages are based on only a few occupations: nurses, clerical personnel and technicians. Other employees don't count. Office rent is based on Housing and Urban Development apartment rental data that doesn't have any connection with the cost of office space.
The Grassley amendment requires the Department of Health and Human Services to analyze, evaluate, and make appropriate adjustments to ensure accurate, geographic adjustments of payments around the country. The changes would be effective as of January 2012, with a two-year transition period during which time states would benefit from a higher adjustment.
The Finance Committee also agreed through unanimous consent to support legislation introduced by Grassley and Senator Jim Bunning, R-Ky. The legislation would require members of Congress and congressional staff to access health insurance through the exchange that would be created by the health care reform legislation under consideration by the Finance Committee. Currently, members of Congress and their staffs participate in the Federal Employees Health Benefits Program. Grassley explained his reasoning behind the legislation saying that having Members of Congress participate in the exchange is consistent with his long-held view that Congress should live under the same laws it passes for the rest of the country.
Although those two amendments were passed, the Finance Committee has twice defeated efforts to create a government-run insurance plan. The two votes on amendments to create a public option were defeated by votes of 15 to 8 and 13 to 10.
Committee Chairman Max Baucus, D-Mont, was one of three Democrats who voted no on both proposals. Baucus said he supports the principle of a public option as an alternative to private insurance. But he warned that including it could doom the bill to a Republican filibuster. He said no one has been able to show him how to count up to 60 votes with a public option.
Debate on a public option is expected to continue. Senate Majority Leader Harry Reid, D-Nev., could include a government plan when he combines the Finance Committee's bill with Senate Health Committee legislation approved in July that includes a public option. Reid predicts that floor debate on a health care overhaul will begin Tuesday, Oct. 13 and the first roll-call vote will be later that same day. Reid shortened the normal Columbus Day Break to accommodate the extra time needed to work on health care legislation.