Multiple Streams Framework Comparison of Anesthesiology Medicare Payment Policies in the United States Congress

In 2007, anesthesiology policy was a salient topic in the House of Representatives, with two bills introduced within nine days of each other: the Medicare Access to Rural Anesthesiology Act of 2007 (MARA) and the Medicare Anesthesiology Teaching Funding Restoration Act of 2007 (MATFRA). A key distinction between these proposals was the presence of competing policy approaches addressing anesthesiology reimbursement and workforce considerations, with the MATFRA regarded as more technically feasible and cost-effective. Kingdon’s (1984) Multiple-Streams Framework explains why MATFRA passed Congress, and MARA has failed to progress.