WASHINGTON, D.C. — Hundreds of amendments to the Senate health care bill — 376 in all — have been filed so far, and more are on the way. Some would overhaul the bill, some are intended to stall it, while others deal with details.
Sixteen of them come from Sens. Amy Klobuchar and Al Franken, and a MinnPost analysis of the Minnesota Democrats’ proposals show that most are concerned with details of how health care reform will work — not an unexpected revelation, sure, since Klobuchar and Franken are generally supportive of health care reform in concept (though Klobuchar has expressed “serious concerns” about how the current bill looks).
Many of them, like a Franken amendment on diabetes prevention and a Klobuchar-backed amendment on home health-care communication technology, are retreads of additional bills that haven’t been passed yet this session.
Not all 376 amendments will come up for a vote. Instead, staffers for Klobuchar and Franken said the goal is to get them in a “manager’s amendment” — essentially a bunch of amendments combined by Senate leaders into one. Those that don’t, and haven’t been filed separately, are likely to be introduced as independent bills later — but almost certainly not as high on the legislative priority list as health care reform.
“That’s why you do them with other people — that’s why I picked [Maine centrist Republican] Susan Collins as my co-sponsor on the neurology one, because she may be still in the game on the final vote,” Klobuchar said of her strategy on one particular amendment.
It also helps to have a large group of co-sponsors and backing of related industry and lobbying groups — a breast cancer awareness amendment Klobuchar is backing is an example, popular with a large group of lawmakers as well as the American Cancer Society and Susan G. Komen Foundation.
MinnPost’s list includes one amendment that would have been filed but was included by Senate leaders as the bill has evolved. That one is the Medicare value index, which would attempt to include quality-of-care metrics as part of the overall reimbursement rate. Klobuchar and Franken are both fighting to keep the measure in the final bill draft — Klobuchar called it her most important amendment — and it appears likely they will be successful.
The exact formula is yet to be determined — a commission under the Department of Health and Human Services would draw up a formula by 2017 based on factors such as mortality, morbidity and readmission rates — but it’s expected to boost dollars to Minnesota, which has one of the highest health service quality rates in the nation.
“Right now, the Health and Human Services secretary will figure out how to use the value index, but I’m hoping it will be subject to a new baseline,” said Franken, adding that he recently talked to HHS Secretary Kathleen Sebelius and she indicated she would support changing the base reimbursement rate, which pays Minnesota providers far less than those in most other parts of the country.
“I think it’s pretty certain it’ll happen,” he said. “It just may not happen in the legislation.”
Franken has submitted three other amendments:
• A requirement that 90 percent of health insurance premiums for group insurance plans, and 85 percent for individual plans, be spent on health care costs. Standards in the current measure are 80 percent for group plans and 75 percent for individual plans.
• Administrative simplification guidelines so that medical providers submit the same information to every insurer, which leads to the usage of the same forms across all plans. Franken said a similar rule in Minnesota has saved the state $60 million a year in administrative costs.
• An expansion of a diabetes prevention program that, in its pilot, cut the onset of diabetes among prediabetics by 50 percent.
Klobuchar has filed or co-sponsored 11 amendments, and is working on another. The one still in the works would address how medical device manufacturers would pay an estimated $20 billion in new taxes or fees over the next 10 years. Her office said details of that are still being worked out, but it would likely be in the form of fees, rather than the excise tax used in the House health care bill.
Here’s what the other 11 amendments would do:
• Authorize a fast-track paramedic training certification for veterans who have medical training.
• Ease drug importation rules to allow for FDA-approved drugs to be imported from other countries. This would legalize a common practice for the many Minnesotans who make the local pharmacy one of their tourist destinations when visiting Canada.
• Expand incentives and training opportunities for medical students who want to practice medicine in rural areas.
• Require that Medicare and Medicaid payments to providers and suppliers by insurance companies be made through direct deposit or electronic funds transfer. The amendment is intended to curtail problems with fraud through paper checks. Individuals would not be subject to the requirement.
• Begin a pilot program to expand the use of home monitoring and communication technologies by home health care agencies.
• Provide additional information and consultation to caregivers who look after a Medicare or Medicaid beneficiary.
• Add neurologists to a primary-care bonus program in Medicare.
• Require the HHS Department to develop a breast-cancer awareness campaign targeting young women and high-risk groups, as well as provide financial assistance to organizations that assist them.
• Adjust federal sentencing guidelines on health care fraud.
• Augment settlement rules for brand-name and generic drug manufacturers in an effort to deter settlements between the two that delay the introduction of lower-cost generic drugs.
Derek Wallbank is MinnPost’s Washington, D.C., correspondent., He can be reached at dwallbank[at]minnpost[dot]com.