ASRM Washington Wire

SCHIP and Medicare
Physician reimbursement in the Medicare system is still under siege. While cuts in physician payments were narrowly avoided last year, even larger reductions are still scheduled to take place for the coming fiscal years. Fortunately, there is a bill moving through Congress that would correct the problem.

The House of Representatives has included a provision in its version of the bill to re-authorize the State Children’s Health Insurance Program (SCHIP) that would eliminate the 15% reduction in Medicare physician payments currently scheduled for FY 2008 and 2009. The House bill would use money from overpayments to private insurance companies in the Medicare Advantage program to prevent the reductions in physician payments.

The House version of the bill also funds, but makes some changes in, the federal government’s “abstinence education” programs. These programs would still receive federal money, but would allow states to fund programs designed to teach those who are sexually active how to reduce the risk of disease and unintended pregnancy.

The Senate version of the bill does not include the Medicare physician payment provision and only increases funding for the SCHIP by $35 billion; the House is increasing funding by $50 billion. Unfortunately, the President has indicated he would veto either version of the bill. If legislation is not passed by September 30, millions of children currently covered by the program risk losing their health insurance, and if Congress does not rectify the physician payment situation, physicians in Medicare will be facing drastic cuts in the coming years.

Congress Adds Requirement for “Tamper Resistant” Prescription Pads to Iraq Funding Bill
This summer, as Congress passed the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 (aka the Iraq Funding bill) they inserted a provision requiring all Medicaid providers to have “tamper resistant” prescription pads by October 1. ASRM has joined an effort led by the AMA to delay implementation of this requirement by at least 12 months.

States Tackle Stem Cell Issues
In late August, Illinois joined the list of states whose legislatures had approved state funding for stem cell research. New Jersey will have a ballot issue this fall which, if approved, will use state bonding authority to fund stem cell research. Meanwhile, in Missouri, research opponents are attempting to pass a ballot initiative in 2008 that would effectively repeal the pro-research measure passed last fall in the state. The measure drafted by the research foes would define human life as beginning when an egg received its full set of 46 chromosomes. Physicians and scientists in the state were quick to point out that people with certain chromosomal conditions would not be defined as human under this wording.

Texas Supreme Court Lets Embryo Decision Stand
In August, the Texas Supreme Court refused to hear the appeal of a divorced Texas woman seeking custody of embryos created with her eggs and her former husband’s sperm. The court did not issue an opinion.

Augusta Roman was originally given control of the embryos by the trial court, but that ruling was appealed by her ex-husband, Randy Roman. Mr. Roman prevailed in the Texas Court of Appeals, the court finding the cryopreservation consent form they had initialed to be a valid and enforceable agreement. The form stipulated that the embryos be discarded if the couple divorced.

The couple had tried various fertility treatments for two years before undergoing IVF early in 2001. Several hours before the embryo transfer was to take place, Mr. Roman informed his wife that he could not go through with it and that he had doubts about their marriage. The transfer was cancelled and the embryos frozen.

After counseling, the couple decided to divorce, but could not agree on the disposition of the three embryos they had in frozen storage. Mrs. Roman wanted to use them to try to have children, releasing Mr. Roman from all parental obligations. Mr. Roman wanted the embryos to be destroyed or to remain in indefinite storage.

Such cases have come before the courts in several states, and generally, the courts have supported the right of one ex-spouse to not procreate over the right of the other to procreate. There have been no federal rulings on the issue, but in interviews this past spring, referenced in a Los Angeles Times article, both Mr. and Mrs. Roman said they intended to appeal to the United States Supreme Court if they lost in Texas.

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