AMCNO Ohio Election Update

November 2, 2010 was a truly historic day in Ohio. Republicans won all five statewide constitutional offices led by Governor-elect John Kasich. They picked up two State Senate seats (taking the GOP majority in the upper chamber to 23-10) and resoundingly took back the Ohio House of Representatives by picking up at least 12 seats for a 58-41 majority come January. Two seats remain too close to call. Depending on how these contests are resolved, Republicans could hold a 60-39 majority in the Ohio House.

While the winds of change blew through Ohio at tornado-like speed, the lasting impact of this election will be felt for years to come. The Ohio Apportionment Board, which consists of the Governor, Secretary of State and Auditor of State, draws the legislative boundaries for the Ohio General Assembly and U.S. Congressional districts. These districts must be drawn in 2011 (based on the 2010 Census report). With Republicans sweeping the statewide offices, the apportionment board will likely draw state and congressional districts that significantly benefit Republican candidates, making a Republican majority the likely political environment in Ohio for the next decade.

The more immediate impact of this election suggests a potentially contentious legislative calendar for the balance of 2010. While the outgoing Strickland Administration and House leadership may wish to complete some of their objectives prior to leaving office, the Ohio Senate will likely want to wait until Republicans are firmly in control of the Governor's office and the Speaker's gavel before tackling any major policy items. Whether late in 2010 or early in 2011 a number of issues such as pension reform, the state capital bill and the state operating budget will be addressed in the months ahead.

On the federal side, Republicans have regained control of the U.S. House of Representatives, and Ohio Congressman John Boehner is the presumed next Speaker of the House. Ohio will send five new members to the House of Representatives, and one - Rob Portman - to the Senate, all of whom are Republicans. The Ohio Congressional delegation will consist of 14 Republicans and six Democrats come January.

With Medicaid making up nearly one-third of Ohio’s budget, the AMCNO will work with the new Ohio legislature in an effort to ensure that cuts to physicians’ Medicaid reimbursement rates do not occur, although this may be difficult to achieve since the Republicans have indicated that they do not want to raise taxes or increase the size of government. With so much change in government, it will be important for the AMCNO to develop a strategy on how to effectively navigate through this new environment.

Two of the most critical races in Ohio for physicians were those of Justice Maureen O’Connor and Justice Judith Lanzinger. Both of these Justices have records of maintaining a philosophy of judicial restraint and both Justices have voted to uphold certain tort reforms. Due in large part to support from the AMCNO and the physician community, NOMPAC-endorsed candidate Justice Maureen O’Connor was elected as the first female Chief Justice of the Ohio Supreme Court and Justice Judith Lanzinger was re-elected to the Court.

At the federal level, concern continues with regard to the impending Medicare payment cuts. The Academy of Medicine of Cleveland & Northern Ohio (AMCNO) has written to Congress on numerous occasions regarding the impending Medicare payment cuts. The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (P.L. 111-192) stabilized Medicare physician payments only until November 30, 2010. Beginning December 1, 2010, unless something changes under the law, Medicare payments for physician services will get hit with a 25% reduction over two months, according to the final 2011 physician fee schedule released Nov. 2 by the Centers for Medicare & Medicaid Services. CMS revised that downward from its original estimate of a 29.5% cut. Pay is still slated to go down 23% on Dec. 1 but would go down 2% -- rather than 6.5% -- on Jan. 1, 2011, assuming Congress takes no action.

The AMCNO has stressed to Congress that they must act – they must break the yearly cycle of putting a band-aid on this problem – they must take action on legislation to provide permanent stability in the Medicare program. Unfortunately, during 2010, Congress once again enacted short-term measures with regard to the Medicare payment issue and on several occasions they did not act in time and Medicare payments were cut by more than 20 percent. As a result of this lack of Congressional action, the Centers for Medicare and Medicaid Services ordered carriers to hold payments until legislation was passed. This payment delay caused disruption in physician practices across Northern Ohio.

The next payment reduction scheduled for December 1, 2010 falls during the timeframe when physicians will have an option to change their Medicare participation status. It is possible that physicians will be considering whether they can continue to accept Medicare rates at the same time that massive payment cuts are scheduled to take effect. The AMCNO has informed Congress that it is time to permanently replace the Sustainable Growth Rate (SGR) formula once and for all. 

Following the recent election, it is possible that the lame-duck Congress will pass a one- or two- month SGR reprieve and leave it to the new Congress to pass a longer patch to get through 2011. AMCNO members are urged to once again contact their Congressional representatives and ask them to take immediate action with regard to the impending Medicare payment cuts.