The More Things Change, the More They Remain the Same
Yesterday, over 100 million Americans went to the polls. Today, we have the same President, Barack Obama, serving an additional four years. The Senate in the 112th Congress consisted of 51 Democrats, 47 Republicans, and two independents that voted with the Democrats. Despite a disproportionate number of Senators up for election being from among the 53 comprising the Democratic Senate Caucus (23 of the 33 seats were being defended by Democrats/Independents), the Senate in the 113th Congress will be comprised of at least 53 Democrats, 2 Independents likely voting with the Democrats, and 45 Republicans. The House, as they were elected to the 112th Congress, was comprised of 242 Republicans and 193 Democrats, and those numbers didn’t change much—with about a ten races still too close to call, as of today, we are sure that the 113th Congress will start with at least 233 Republicans and at least 192 Democrats.
So, after over $2 billion expended on the Presidential and campaigns alone, and a total of $6 billion on federal elective offices, the country has voted largely to perpetuate the status quo. Oh, there has been some change, and more rumination and hand wringing will occur. Pundits will observe the virtually unprecedented circumstance where a sitting President has been re-elected with unemployment at or near 8% throughout his entire first term. One GOP Senator said the answer is that GOP demographics must be re-examined. The most striking poll statistic I heard was the finding that roughly 28% of the public had experienced a major breach with someone within their own family about this election…the politics may not have changed much, but elections still can take a heavy toll!
Where does all of this leave us in orthotics and prosthetics? It is said that the stock market likes certainty. Well, I think we are now pretty certain that the Obama health care reform law will be implemented. Within the next few weeks, we expect the administration will roll out final regulations that were potentially too toxic to roll out in the midst of an election campaign—we look for a final rule on essential health benefits (with luck, one that will be even clearer about the inclusion of O&P services than what we have seen previously). We expect also a final rule on the medical device excise tax, and again, we are pretty hopeful that O&P patient care facilities, and very possibly O&P component manufacturers will be exempted. That $716 billion in Medicare cuts that were enacted to pay for the health care reform law—including greatly heightened RAC, CERT and pre-payment audits—they’ll be with us (AOPA has fought this one tooth and nail—we are promised a proposed fix from the CMS Administrator by December 1; if not, we may have to look to other possible remedies, including the possibility of litigation against Medicare). Additionally, Medicare is line to pay its share of the costs of sequester inspired deficit reduction—right now, if sequester occurs we are limited to another 2% in cuts. But, there will be a major push to change the sequester, and to reduce cuts to defense, which means Medicare could be called upon by Congress to make up a greater share!
Looking longer term, perhaps the biggest fear ought to be that the past is a prelude. Could we actually have both parties renege on any commitment to govern or to act to improve the economy, choosing instead to posture again for the next election? Will Congress fail to address huge deficits, expiration of the Bush tax cuts, opt for sequestration and plunge the economy into a major “fiscal cliff” second dip recession/depression—placing not only the Nation’s credit rating, but the global economic picture is grave jeopardy? Will Congress, once again, kick all these important decisions “down the road” 3-6 months, or might we have a “lame duck” session which actually tackles at least some of these issues?
Those are the big questions that are beyond our capacity to answer as the O&P field that is responsible for less than 0.5% of the U.S. Medicare expenditures. But they will have their impact on us for sure. While it is not a very rosy or clear picture, we at AOPA pledge our continued efforts to exercise every creative initiative we can muster to try to tackle the challenges that most directly threaten O&P and to try to hammer out workable solutions. But we need your help.
For our part, doing this demands resources and support—the O&P field and your patients deserve the best, but we also need to hammer home that AOPA can’t fight and win these major battles unless virtually every company in the field IS an AOPA member and is contributing to the solution—nothing less will do to assure your fight to serve your patients and receive a fair compensation for those incredibly valuable services you deliver each day. The next time you speak to a colleague whose company is not an AOPA member, do them and yourself a favor by giving them a copy of this letter and telling them how critical it is for them to join AOPA.