The House's latest version of their healthcare legislation is 1,900 pages in length and the Speaker has mandated a vote on the 1,900 page bill by week's end, giving America and the Congress less than 5 days to read and analyze it. How can this be viewed as reasonable? Thus far, the bill has been analyzed by the Wall Street Journal and outlines billions of dollars in spending, tax increases, and heavy regulation. The CBO score indicates that the bill will cover approximately 6 million Americans and at a ten year cost of at least $1.1 Trillion -with other experts indicating that it will be $2 Trillion at least- it works out to $500,000 per person covered. CBO goes on to state that all indications indicate that the cost of a policy in the "exchange" will exceed the cost of the same policy from the current private sector. On the reimbursement side of the equation, reimbursement will be negotiated with HHS, something sure to result in Medicare or near Medicare conversion factors for all and those experts that have reviewed it have indicated that it will kill the private commercial insurance industry in 5 years. The net impact upon the payermix/casemix of today's anesthesia practice by this legislation will be nothing short of disastrous. The reality of it means no matter what your practice environment or what your employment relationship is, the future under this legislation holds nothing but plummeting conversion factors for CRNAs and MDAs across the nation. As the national average conversion factor takes a negative hit of 25%, 50% or more, so goes the annual earnings of CRNAs. Despite what some believe, the current fiscal crisis has increased the awareness of CRNA reimbursement and its relationship to CRNA earnings packages. There is a growing understanding of the direct relationship between CRNA earnings -no matter how you are actually paid- and the reimbursement for CRNA services. Loss of a sustainable future for the profession will more than likely have an impact upon anesthesia school enrollment and the ability of the profession to meet future manpower needs. Contact your members of Congress today and voice your concerns and opinions.