Reconciliation Process and Last-Minute Deal Create Challenges for O&P Field

The U.S. House of Representatives passed health care reform legislation on Sunday, March 21, after an intense and controversial weekend of last-minute negotiations to persuade wavering Democrats to vote for the bill. With a vote of 219 to 212, the House first passed the Senate health reform bill as is, and then proceeded to pass a package of amendments – the reconciliation bill – by a vote of 220 to 211 that modified the just-passed health reform bill, according to a National Association for the Advancement of Orthotics and Prosthetics (NAAOP) news release.

The health reform bill will now be sent to the President Barack Obama for his signature which is expected to occur on Tuesday while the reconciliation bill, which also includes a significant set of changes to the student loan program, will go to the Senate. The Senate is expected to debate the bill this coming week and while passage has been forecasted by Democratic leaders, many challenges remain. Multiple amendments to the reconciliation bill are expected to be offered which may necessitate a return of the bill to the House for another vote.

The Senate amendment process may be necessary to modify a provision that was agreed-to late last week when a group of congressmen representing districts with a heavy presence of medical device manufacturers convinced House leadership and the White House to reduce the amount of the new tax of 2.9% on Class II and Class III medical devices to 2.3% in exchange for expanding the base of this new tax to Class I medical devices as well. This means that O&P manufacturers and companies that import Class I medical devices will be subject to a tax that for the past 10 months during the course of the health reform debate did not materially impact orthotics and prosthetics. NAAOP will be working with other O&P partners to try to change this outcome.

In addition, resorting to the reconciliation process had the impact of eliminating the House-passed language that explicitly clarified coverage for “durable medical equipment, prosthetics, orthotics, and related supplies” in the standard benefits package that health plans must offer. The final bill does cover “rehabilitation services and devices” which has always been viewed as including coverage of O&P care. But this means that additional efforts will be required throughout the regulatory process to ensure that O&P is a covered benefit in the standard benefits package. NAAOP is working with the O&P Alliance and many other organizations to lay a foundation for this through the bill’s legislative history.

The underlying health reform bill will soon become law, but the reconciliation bill is still in play.

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