Postelection moves signal healthcare reform action

President-elect Barack Obama's appointment of former Senate Majority Leader Tom Daschle to head the Department of Health and Human Services, combined with a commitment from insurers and a detailed plan from the chair of the powerful Senate Finance Committee, suggests strongly that healthcare reform will be a top priority for the new administration and the 111th Congress.

As director of the federal department that oversees Medicare and Medicaid, Daschle will likely play a pivotal role in refining the reform plan articulated by Obama during the presidential campaign. He is also expected to draw on his extensive contacts in Congress to promote acceptance of legislation.

Daschle's appointment on Nov. 19 had policy analysts scrambling for his book, Critical: What We Can Do About the Health-Care Crisis. In it, the South Dakota Democrat expresses support for policies similar to those proposed by the president-elect. Like Obama's, his plan would retain employer-based insurance and create federally subsidized insurance programs covering children, the uninsured, and employees of small business. Unlike Obama, Daschle would require everyone to participate in the plan.

Both Obama and Daschle support the creation of a federal board or agency that would conduct comparative cost-effectiveness and clinical outcomes studies to determine if therapies and devices, including those crucial to medical imaging, warrant reimbursement. The Daschle appointment sent a signal that work on healthcare reform will begin soon after Obama's Jan. 20 swearing-in, said Josh Cooper, senior director of government relations at the American College of Radiology.

"The folks I've spoken with and the pundits I've listened to agree that former Sen. Daschle probably would not have accepted the post if he did not have assurances that healthcare would be a priority that would be addressed rather quickly," he said in an interview with Diagnostic Imaging.

Daschle's appointment came a day before America's Health Insurance Plans, a lobbying group for insurers, announced that it would support aggressive reform, including coverage of people with preexisting conditions, if congressional lawmakers made participation mandatory. The AHIP proposal is notable in light of its staunch opposition to universal healthcare coverage proposals by the Clinton administration in 1993.

The flurry of postelection activity began Nov. 12 when Finance Committee chair Max Baucus (D-MT) released a 98-page white paper describing his vision of an insurance-based reform package. The Baucus proposal was based on findings from 12 hearings before the Finance Committee in 2008 and a day-long consortium where providers, policymakers, insurance companies, and analysts laid out their requirements for remaking the healthcare system.

As noted by the ACR, the Baucus proposal for universal coverage would revolve around a nationwide insurance pool called the Health Insurance Exchange. It would act as a marketplace for individuals to purchase coverage. The current system of employer-sponsored healthcare coverage would be retained, but disenfranchised individuals would use the exchange to select subsidized coverage from plans that promise not to discriminate against applicants with preexisting medical conditions.

Medicare and the State Children's Health Insurance Program, a popular initiative that covers the children in otherwise uninsured families above the poverty line, would be expanded. Medicaid would be retained, and new programs emphasizing preventive health and professional accountability for quality medical practices would be established.

Of importance to radiologists and medical imaging providers, the Baucus plan would invest in a new institute for comparative effectiveness research and health information technology. Its strategy for controlling healthcare costs would include requiring the disclosure of payments and incentives to providers by drug or device makers that may be lead to biased decision making. Medical malpractice reform would be considered as well.

An ACR analysis of the plan notes that it addresses the need for physician payment reform and moves away from the current sustainable growth rate formula. The SGR threatens to cut physician payment rates for Medicare Part B services by more than 20% in 2010.

Baucus acknowledged the possibility of replacing SGR with spending targets similar to those aimed at MRI, CT, and PET in the Children's Health and Medicare Protection Act of 2007. The ACR and other imaging-related societies joined forces in a rare show of unity to forcefully oppose the legislation, sponsored by Rep. Fortney "Pete" Stark (D-CA). It passed the House but was not considered in related Senate legislation.

ACR officials were bolstered by recommendations in the Baucus plan that appear to recognize the clinical proficiency of radiologists and their unique position as nonreferring physicians, according to a statement. Specifically, the Baucus white paper noted "in the case of a separate target based on utilization and growth in imaging services, physicians who refer patients for imaging services usually do not receive payment for the performance or interpretation of those services."

Baucus, however, supports a close examination of the growing costs of advanced imaging utilization and fees.

"They mentioned self-referral as one area to explore. They also want to explore other quality measures," Cooper told Diagnostic Imaging. "But we were generally pleased with what Sen. Baucus's paper had to say about imaging."

For more information from the Diagnostic Imaging archives:

Radiology searches for a place in healthcare reform puzzle

Final rules in 2009 Medical Physician Fee Schedule disappoint some, elate others

Universal coverage may mean practice changes