Physician Hospital Executive Director Molly Sandvig Discusses What Happens Next With Health Reform

"The prospect of being hanged focuses the mind wonderfully," Samuel Johnson said. Physician-owned hospitals, which would be stopped dead under the health reform bills, have therefore monitored the bill-making process oh-so very carefully.

Molly Sandvig, executive director of the Physician Hospitals of America, has paid close attention to what may happen in the future to the bill, now that Senate Democrats lost their 60-vote, filibuster-proof majority in a special election in Massachusetts.

"There is near panic in the Democratic caucus," Ms. Sandvig observed in a new report to PHA members. "The question baffling Washington is, what happens next on healthcare reform?" Her report lays out the following possible scenarios for the bill and explains advantages and pitfalls for each:

1. Congress continues with House-Senate reconciliation. Senate Democrats try to win over one or two Republicans to overcome the filibuster threat and allow both houses of Congress to continue reconciling differences in the versions of the bill. But this appears to be the least likely scenario. The Massachusetts upset only seems to have solidified opposition to the reform bill.

2. House accepts the Senate-passed bill. Congress sends the Senate-passed bill directly to President Obama and then immediately follows with changes and corrections to satisfy House Democratic constituencies. However, "it is by no means a sure thing that the House would accept the Senate bill or trust the Senate to act quickly on the follow-up legislation," Ms. Sandvig said. Moreover, obtaining the 218 votes needed in the House seems "almost impossible" because House members are "reacting nervously to the Massachusetts elections and feeling an anti-incumbent mood."

3. A much smaller bill is passed. "It appears that the Democratic leadership truly feels that they need to pass some kind of healthcare legislation and that to do nothing on their signature issue would wreak havoc in November," Ms. Sandvig observed. Democrats might fashion a much smaller bill made up of widely popular provisions such as limits on health insurance company practices. Such changes, however, may have harmful outcomes. For example, stopping plans from denying coverage based on pre-existing conditions could drive up premiums.

4. Reform bill is set aside, for now. "Congress could step back, take a deep breath and move to a jobs bill and other issues, " Ms. Sandvig said. The issue could then be revisited later this year, before the November elections. White House, House and Senate officials have suggested this, but time may run out and Congress might never get back to health reform before the election.

All this doom and gloom about health reform is, of course, very elating for physician hospital owners, but not so fast, Ms. Sandvig warns. "The issue of physician ownership is not going away, and if health reform of any kind moves, PHA anticipates that the negative language will be part of the effort," he said.

"In addition, there will be other bills this year that could provide a vehicle for opponents to add provisions antithetical to the industry," she added. "PHA will be closely watching all of these possibilities and has already taken steps to try to close off certain avenues."

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