Blue Dogs combat liberal reforms, take no stance on self-referral

Blue Dog Democrats on the House Energy and Commerce subcommittee on health were credited Friday with combating liberal proposals arising during protracted deliberations that would have cut physician pay. No action was taken on an amendment that would have banned in-office imaging physician self-referral.

"I give them credit for taking a bill that was extremely left of center and putting in some provisions that moved it a little bit more toward the middle," said Cynthia R. Moran, assistant executive director for government relations and economic policy at the American College of Radiology.

The Blue Dog Coalition, a fiscally conservative group of House Democrats, has gained influence serving as a power broker between Democrats and Republicans. It has also shown clout securing compromises between liberal and conservative Democrats in the House.

Blue Dogs were particularly prominent during crucial energy and commerce subcommittee deliberations by forcing negotiations on key aspects of the healthcare plan. Six of the subcommittee's 23 Democratic members are Blue Dogs.

They include John Barrow (D-GA), Bart Gordon (D-TN), Jane Harman (D-CA), Jim Matheson (D-UT), Mike Ross (D-AR), Zack Space (D-OH). Without their support, majority Democrats may not be able to pass reform legislation.

"It's safe to say that the Blue Dogs contributed significantly to making this a more palatable bill for the physician community," Moran said.

Blue Dogs have opposed proposals that would have given the Obama-backed health insurance option the power to set physician payment rates. That may have had major effect on reimbursement rates for radiologists and other specialists in rural and urban areas, Moran said.

On Thursday night, they cut a deal with committee chairman Henry Waxman (D-CA) and other Democratic leaders to preserve subsidies for people who cannot afford healthcare insurance while promising substantial cost cutting elsewhere in the bill. Another concession guaranteed that no one will be forced to enroll in the public option plan.

"They (Blue Dogs) are trying to get the payments boosted up for rural providers across the board. If it happens, that would be positive for radiologists just as it would be for any other provider," Moran said.

Blue Dogs have not factored into provisions imposing a 75% presumed utilization rate for the Medicare relative value formation of outpatient MRI and CT reimbursement or increasing the payment discount for advanced imaging modalities to examine contiguous body parts. Both reforms, opposed by radiologists, remain in the House bill. The committee did not consider an amendment to eliminate the in-office ancillary equipment exemption to federal Stark anti-referral law.

Deliberations continued late into Friday night as Waxman attempted vote the bill out of the subcommittee before adjourning for the month-long August recess. The House Ways and Means subcommittee on health and education and the Labor Committee had already approved their sections of the so-called tri-committee reform bill.

A positive vote from the Energy and Commerce subcommittee would clear the way for introducing the 1000-page bill on the House floor when Congress reconvenes in September. The Senate Finance Committee was unable to introduce reform legislation before the recess.