BETHESDA, MD 25 February 2010—With the White House on February 22 offering a proposal—actually a summary of a proposal—to comprehensively reform health care amid recent inaction by Congress, the pharmacy provisions in existent legislation have an uncertain future, according to the ASHP staff members in charge of communicating with Congress.
The proposal, the White House said, incorporates the work that the House of Representatives and the Senate have done and adds ideas from Republican members of Congress.
But the proposal’s summary does not specifically mention pharmacist-provided medication therapy management (MTM) services or involvement of pharmacists in the medical home model of care.
Those two provisions are in the House- and Senate-passed bills on health care reform, are not controversial, and should weather congressional discussions if they occur, said Brian M. Meyer and Joseph M. Hill of ASHP’s Government Affairs Division on February 9.
Congressional efforts to agree on a single piece of legislation to reform health care slowed when the Senate’s composition changed earlier this year.
Massachusetts voters in January elected Republican Scott Brown to the U.S. Senate to serve out the term of Democrat Edward Kennedy, who died in August 2009. A governor-appointed Democrat had been serving in the Senate since Kennedy’s death.
With Brown in the Senate, this 100-member group consists of 57 Democrats, 41 Republicans, and 2 senators who do not belong to either major political party but are part of the Democratic caucus.
Democrats in the Senate now lack the 60 votes needed to end any debate on harmonizing the House and Senate versions of health care reform.
Senate Republican Leader Mitch McConnell has said his party’s senators want to start from scratch on legislating health care reform.
In the House of Representatives, the January 3 resignation by Florida’s Robert Wexler and February 8 death of Pennsylvania’s John Murtha lowers to 218 the number of still-serving members who voted aye on the health care reform legislation.
The House has 435 voting members. For a piece of legislation to pass, at least 218 representatives must vote aye. Votes on the House’s bill on health care reform did not fall cleanly along party lines.
"It is a legislative and political imperative, at least for the Democrats, to deliver something to Obama," said Meyer, director of the ASHP Government Affairs Division.
The big unknown, he said, is the exact content of the legislation that the Senate and House will wind up passing and sending to the White House.
Hill, director of federal legislative affairs, said ASHP favors health care reform through legislation "along with everyone else in the country who says that it’s time for health care reform."
A February 4–8 telephone survey of a random national sample of 1004 adults found that 63% want Congress to keep trying to pass a comprehensive plan for health care reform. The Washington Post–ABC News survey also found that 88% of Democrats, 55% of Republicans, and 56% of independents in the sample want Congress to keep trying.
"Where people disagree on [health care reform]," Hill said, "is the manner in which we get there."
He said ASHP’s main objective on this front is to ensure that pharmacists are part of the "health reform equation."
"We’re in favor of the reform effort as long as it involves pharmacists," Hill said. "Our efforts don’t reach into whether or not the government should be in the health insurance business," for example.
He said the policy statements developed by the ASHP Council on Public Policy and approved by the House of Delegates and Board of Directors guide the actions that the Society takes regarding legislation.
The long-standing ASHP Statement on Principles for Including Medications and Pharmaceutical Care in Health Care Systems, while not containing the phrase "medication therapy management services," states that health care systems must provide for pharmacists’ health care services.
Last year, the House of Delegates and the Board approved the policy position Pharmacist Role in the Health Care (Medical) Home. That policy position requires ASHP to advocate to health policymakers for the "inclusion of pharmacists as a care provider within the health care (medical) home model."
Meyer said the Senate- and House-passed bills call for the creation of a grant program to pay for pharmacists to provide MTM services to certain patients.
The bills, he added, provide better definitions of MTM services than does the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which created Part D.
Both bills also require the secretary of Health and Human Services to submit to Congress a report assessing the outcomes of pharmacist-provided MTM services.
Such a report, Meyer said, would overcome policymakers’ reluctance to extrapolate the findings of the relatively small-scale studies that have been conducted to date.
Neither piece of legislation requires Medicare Part B to recognize pharmacists as providers. But Meyer said the MTM grant program offers "a potential pathway for providing the needed data to make the case for provider status."
Hill, before the White House released its proposal for health care reform, described three possible courses of action in Congress: (1) the Senate could divide its bill into pieces and work on the "noncontroversial" parts, (2) either house could table the issue altogether, or (3) the House could pass the Senate bill and then, through a budget reconciliation bill, work out the differences between the House and Senate bills.
If no bill for comprehensive health care reform passes this year, he said, ASHP could pursue its legislative priorities as standalone bills or as provisions to be attached to bills likely to pass.