A plan to eliminate Congress’s annual scramble to protect doctors from cuts to Medicare reimbursement was hailed as a triumph of bipartisanship when it sailed through the House of Representatives last month. But some Senate conservatives aren’t ready to give the bill a free pass through their chamber.
Before embarking on its latest recess, the House of Representatives last month overwhelmingly passed a bill to remove the need for what has become known as the “Doc Fix,” an annual measure taken by Congress to avoid complying with one of its own pieces of legislation.
In 1997, Congress passed the Balanced Budget Act, which contained a provision meant to limit the growth of Medicare costs by imposing what was called a “Sustainable Growth Rate” formula. The SGR, however, quickly became controversial as it was found to require large cuts to reimbursement for doctors who treat Medicare patients. Rather than fix the problem, though, Congress began passing annual patches that waived SGR compliance.
Nobody was happy with the recurring need for a “Doc Fix.” Doctors complained about the uncertainty it caused, and lawmakers disliked the annual crisis it generated. The main obstacle to a permanent solution, however, was how to pay for a permanent change. The annual fixes were, by and large, offset by other spending cuts. However, a permanent fix would have to be scored over a 10-year budget window, meaning that any offsetting cuts would have to be an order of magnitude larger than the more modest cuts that went with the annual patch.
The agreement struck between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) and passed by the House dealt with the political difficulty of large budget cuts the way Congress so often has: by adding it to the deficit. The permanent fix would add $141 billion to the federal deficit over the first ten years, and could go as high as $500 billion over two decades.
The bill would avert a 21 percent cut in what doctors are paid to treat Medicare patients – a decrease that many physicians say would make them unwilling to continue seeing Medicare users.
While nobody wants to see doctors’ pay cut so drastically, the decision to put the Doc Fix on the nation’s credit card that has some conservative senators suggesting that they will not support the proposal when it comes before them next week.
Sen. Jeff Sessions (R-AL), who criticized the House deal before Congress left town in March, and a handful of other conservatives are said to be considering an amendment to the House bill to require Congress to make offsetting budget cuts that would pay for the plan. Among those believed to be in support are 2016 Presidential candidate Sen. Ted Cruz (R-TX), Sen. Mike Lee (R-UT), Sen. Ben Sasse (R-NE) and Sen. David Vitter (R-LA).
Senate Majority Leader Mitch McConnell said before Congress went on recess that the permanent SGR fix would be a top priority when lawmakers return to Washington next week, and there is reason for urgency. The most recent doc fix expired on March 31, meaning that technically, health care providers ought to be receiving lower payments already.
However, the Centers for Medicare and Medicaid Services has suspended processing claims for services delivered after the deadline until April 15, in the hope that a retroactive resolution will be reached before that time.
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