System reform bill revisited by House panel that OK'd it

Washington -- In a highly unusual move, the House Energy and Commerce Committee on Sept. 23 adopted 23 new amendments to a House health system reform bill that the panel already had approved two months earlier.

Committee Chair Henry Waxman (D, Calif.) had reached an agreement with panel Republicans on July 31, on the eve of the congressional August recess, to revisit several additional pending amendments later, instead of working late into the night.

Rep. Joe Barton (R, Texas), the highest-ranking GOP member on the committee, said during the Sept. 23 markup he could not recall another time in his 25 years in Congress that lawmakers amended a bill after it was adopted.

The panel adopted two packages of 22 amendments and one stand-alone change to the Affordable Health Choices Act. Barton said the packaged changes are noncontroversial and bipartisan. For example, they would allow the Dept. of Health and Human Services to provide grants for employer wellness programs. The committee also unanimously adopted a stand-alone amendment that would require hospitals and health plans to publicize price data.

Waxman said the amendments will be considered as recommendations to the House bill when the House Rules Committee begins combining his panel's bill with similar bills adopted by two other House committees. But the amendments would not have the same weight as the official language in the committee-approved bill, he said.

GOP attempts revisions

The Energy and Commerce Committee also rejected two Republican amendments. One would have allowed participating physicians to balance bill public insurance plan patients. Rep. Michael Burgess, MD (R, Texas), who sponsored the amendment, argued that the change was needed to ensure that patients would be able to see the physicians of their choice. Some doctors opt out of government plans because of relatively low pay. Balance billing also would prevent physicians from charging higher rates to private payers to make up for relatively low government rates, Dr. Burgess said.

But Rep. Frank Pallone (D, N.J.) noted that 47 states prohibit balance billing because it would expose consumers to unexpected charges and co-pays. "Providers shouldn't be charging patients more than the rates they agreed to when they agreed to participate in the plans' network," he said. Waxman added that the House bill would not require physicians to participate in the public plan.

The committee also voted down an amendment by Rep. Lee Terry (R, Neb.) that would have required a new federal commissioner in charge of determining minimum health benefits requirements to disclose all contacts with members of Congress, citizens and organizations. But Pallone worried that the amendment would discourage whistle-blowers and others from speaking to the commissioner because their visits would be part of the public record.

Republicans opened the late markup by arguing the Affordable Health Choices Act should be recalled and significantly amended in light of public comments made against the bill, known as HR 3200, at August town hall meetings.

"The world has changed since we last addressed HR 3200," said Rep. John Shimkus (R, Ill.). "The public has summarily rejected HR 3200 by their own research."

The print version of this content appeared in the Oct 12, 2009 issue of American Medical News.

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