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The U.S Senate has moved one step closer to liberalizing the severe restrictions imposed on physicians who want to sign private payment contracts with their Medicare patients.
On April 3, by a vote of 51 to 47, the lawmakers passed a "sense-of-the-Senate" resolution endorsing the concept that physicians treating Medicare beneficiaries should not be forced into a mandatory two-year opt-out if they enter into a private contracting agreement with even one Medicare patient.
APA, long an advocate of Medicare private contracting, has been a strong backer of a bill introduced by Senator Jon Kyl (R-Ariz.), Senate sponsor of last year's private contracting legislation, that would allow physicians and other Medicare providers to enter into such agreements selectively without having to be completely in or out of the Medicare program.
Unless an amendment to last year's law is enacted, any physician or health care professional will have to sign and forward to regional Medicare carriers an affidavit stating when his or her first private Medicare contract will take effect. From that time on, the caregiver will be barred from receiving Medicare reimbursement for treating any beneficiary for two years.
Physicians and others do not have the option of agreeing to a two-year payment ban with the Medicare carrier serving one area while continuing to be reimbursed for the same period for patients covered by a Medicare insurer covering another area. There are no apparent loopholes in the all-or-nothing provision.
A sense-of-the-Senate resolution puts the body on record in support of or opposition to a particular issue, usually when the Senators are not prepared to put the matter to a formal vote. Thus, it serves as a public statement of Senate opinion but neither enacts nor kills a legislative proposal.
The resolution states that "seniors have the right to see the physician or health care provider of their choice and not be limited. . .by the imposition of unreasonable conditions on providers who are willing to treat seniors on a private basis, and that assumptions underlying the functional totals in this [budget] resolution assume that legislation will be enacted to ensure this right."
The Medicare private contracting provision that Kyl and his allies are now trying to change was passed as part of the Balanced Budget Act of 1997 and amended the Social Security Act.
The two-year exclusionary clause, which replaced a more liberal provision, was added as a compromise with opponents of private contracting, including President Bill Clinton, as a vehicle for getting at least some degree of private contracting into Medicare. Clinton is among the opponents who believe that permitting private contracting in Medicare will contribute to the development of a two-tiered health care system for America's senior citizens (Psychiatric News, November 7, 1997).
APA has for years endorsed the concept of private contracting within the Medicare program, maintaining that patients who want to avoid using government-sponsored insurance for reasons of confidentiality or quality should not be denied the choice of paying for such care with their own money.
In the House, Representative Bill Archer (R-Tex.) has introduced legislation similar to Kyl's, but no action on the issue is scheduled in that body. Archer's initiatives carry considerable weight with his colleagues, however, since he chairs one of the House's most powerful committees-Ways and Means.
Since there is no indication that the Senate will formally vote on Kyl's bill any time soon, advocates of Medicare private contracting will have to remain optimistic that passage of the sense-of-the-Senate resolution, though by a much closer margin than they would have hoped, signals that a majority do favor a loosening of the current restrictions.