President Obama has endorsed moving the Senate health care reform bill (H.R. 3590) forward using the budget-reconciliation process. Saying that he “believes that the Congress owes the American people a final vote on health care reform this year,” the president described a process where the House could vote on the Senate-passed bill, followed by a budget-reconciliation package that includes his changes and other needed modifications. In an effort to garner bipartisan support, the president endorsed inclusion of key Republican provisions in the reconciliation package. As a final step in this process, the Senate would then vote on the reconciliation package, with a simple majority (51 votes) needed for passage.

For medicine, the overarching issue is resolution of the sustainable growth rate (SGR). So far only short-term fixes (30 days, seven months or one year) are under discussion – none of which are acceptable to the Academy and others who are calling for a permanent solution to Medicare physician payment. Problems for medicine in the Senate bill include:

• Creation of a cost-control or advisory board directed to cut payments, primarily to physicians
• Penalties for not participating in the Medicare Physician Quality Reporting Initiative (PQRI)
• Non-discrimination language advocated by non-physicians

In a move to protect them politically, House Democrats are reportedly seeking a commitment/letter from 51 senators promising action on the reconciliation package before they vote to pass the Senate health care reform bill.