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BY LOUIS J. GOODMAN, PHD, TMA EXECUTIVE VICE PRESIDENT AND CHIEF EXECUTIVE OFFICER Government-run health care dates back to the Roosevelt administration and has increased in ev- ery decade since then, culminating in the 2010 passage of the Patient Protection and Affordable Care Act (PPACA) and a fa- vorable Supreme Court constitutional decision in 2012. Much has been written about PPACA, and we are certain to

read and see much more as thousands of pages of regulations are promulgated and the health care landscape is remolded in PPACA’s image. Most recently, the far-reaching tax implications of the law were more widely disseminated and better under- stood by the American people. Immediately before passage of the law, TMA’s polling of

Texas physicians found 18 percent in favor of the legislation and 69 percent opposed. A recent report by The Physicians Foundation found that the large majority of physicians sur- veyed (86 percent) believe the legislation did not adequately address the “viewpoint of physicians.” TMA did not support the onerous Senate version of the legislation. But, when the House concurred with the Senate version and passage seemed all but imminent, we lobbied to send both versions to a confer- ence committee. Unfortunately, that did not occur, and physicians, along with the rest of the population, face the good, the bad, and the ugly provisions of the unfiltered legislation. Accordingly, TMA carefully evaluated the new legislation

from the patient-physician perspective and developed our current policy: “Find What’s Missing, Keep What Works, and Fix What’s Broken.” This policy prescription guides our fed- eral agenda, in cooperation with a consortium of state medi- cal societies, and with the American Medical Association on some issues such as repealing the flawed Medicare Sustainable Growth Rate (SGR) formula. Let’s start with “Find What’s Missing”:

• Repeal the broken Medicare SGR funding formula and enact a fair and rational physician payment system.

• Enact Texas-style medical liability reforms that do not mod- ify or change reforms now in Texas law.

• Pass the Medicare Patient Empowerment Act that allows physicians to privately contract for Medicare services.

We also need to “Keep What Works”:

• Maintain the prohibition on insurance companies from ex- cluding coverage to patients with preexisting conditions.

• Maintain the requirement that insurance companies use a consistent and transparent reporting formula for the “medi- cal loss ratio.”

• Maintain the requirement that insurance companies label their policies in plain English, so patients can better under- stand their coverage.

Finally, we need to “Fix What’s Broken”:

• Repeal the Independent Payment Advisory Board and keep Congress accountable for the Medicare system.

• Increase graduate medical education funding and make ad- justments for future Medicare support based on population growth.

• Remove abusive and unfair provisions relating to the health care fraud criminal statute that punishes physicians for hon- est mistakes and inadvertent billing errors.

• Remove the arduous paperwork requirement for imaging, so physicians can spend more time taking care of patients instead of pushing paper.

• Ensure that all nonphysician practitioners only act within their state scope-of-practice laws.

• Repeal legislation that limits physician ownership of hospi- tals.

• Expand the Health Insurance Portability and Accountability Act to provide adequate funding for physicians to adopt electronic health record technology.

Of course, there are many more provisions in PPACA that

will require support or opposition, but the items listed above are the most imminent and important to Texas medicine at this time. Clearly, the impact of PPACA will be profound. Thirty million more Americans will have health insurance, but will there be enough physicians to care for them? We can expect the retirement of as many as 100,000 se- nior physicians in the next five years, con- comitant with the impending influx of 36 million baby boomers into the Medicare program.1 Our data show that the future pros- pects for Medicaid are substantially worse than for Medicare. The number of Texas physicians available to treat new Medicaid patients has dropped from 42 percent in 2010 to 31 percent this year. The same survey (TMA’s 2012 Biennial

Louis J. Goodman, PhD

September 2012 TEXAS MEDICINE 21

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