After two weeks of debate over amendments to the Chairman's Mark in the Senate Finance Committee, that version of the bill has been completed and a vote is expected next week. A total of 142 amendments were considered. The most controversial components for the AOA were the lack of a permanent fix to the sustainable growth rate (SGR) formula and the establishment of an Independent Medicare Commission (IMC) to set physician payment rates. With respect to the SGR, the Senate finance package includes only a .5% update for 2010, which would revert back in 2011, at which point physicians would face a scheduled cut of approximately twenty-five percent. Senator Debbie Stabenow (D-MI) has indicated that she will introduce an amendment for a long-term fix on the Senate floor. This remains a top priority for the AOA moving forward and we continue to work with members in both the Senate and House to ensure its inclusion in the final bill. The House version, H.R. 3200 included a comprehensive overhaul of the payment formula that is strongly supported by the AOA Earlier this week the Senate Committee confirmed that a deal cut with hospitals included an exemption from the IMC rate-setting provisions. This exemption was not accounted for by the Congressional Budget Office (CBO) in its initial score and is expected to increase costs by approximately $11 billion. The AOA believes that the Medicare program should function as a holistic system in which spending targets consider all parts, rather than imposing budget neutrality solely on Part B. In one of the final amendments considered by the Committee, a modification to the Chairman's Mark intended to clarify the language stated that the Commission is advised to seek reductions in expenditures for Parts C and D. This was largely a rhetorical change and does not eliminate the exemption for hospitals. The AOA strongly opposes the IMC provision overall and is working in conjunction with other physician organizations to eliminate it from the final bill. Two amendments offered by more liberal members of the Finance Committee that would have established a public plan option were rejected on Wednesday. However, Senator Maria Cantwell (D-WA) introduced a significantly scaled back version on Thursday that passed by a vote of 12-11. The proposal would give states the option of offering a public option to individuals at 133-200% of the poverty level. The concept is loosely based on a program in Washington State that would require states to negotiate rates with providers. The AOA is examining the proposal but does not believe that a public option is necessary to achieve a competitive marketplace for insurers. The bill will be scored by CBO and then returned to the Committee for a final vote this week. Following its passage, the legislation will be merged with the version passed by the Senate Health, Education, Labor and Pensions (HELP) Committee. Senate Majority leader Harry Reid (D-NV) has indicated that the final bill will reach the Senate floor the week of October 12th. The AOA believes that the Senate Finance Committee's bill falls well short of meeting our goals for health care reform. We will continue to advocate for those policies contained in the House version that would strengthen the physician workforce, provide equitable reimbursements and ensure that all Americans have access to physician care.