2009-10-15
Senate
Democratic leaders have announced that the Senate will likely begin debate on a
stand-alone physician payment measure (S 1776) next week. The announcement reflects a change in plans
for the larger health reform measure, which originally included a provision to
provide a short-term increase in Medicare payments to physicians as Senate
leaders begin the difficult task of melding the two Senate committee health
reform bills into a single measure that can garner support.
For
almost 10 years, physicians have faced cuts in their Medicare fees that are
dictated by a statutory budget formula known as the sustainable growth rate (SGR). During this period, physicians have generally been able to convince Congress
to reverse the cuts, although at considerable and increasing cost. Beginning January 1, 2010, physicians face an
average 21 percent cut in their Medicare fees. Democrats had planned to reverse
the cut, and perhaps even “re-base” the fee schedule to avert future cuts, as
part of health-care overhaul bills in the House and Senate, but they have
scrapped that plan in favor of dealing with the physician payment issue in
stand-alone legislation.
Deferring
the matter could free up billions of dollars that Democratic leaders could
apply to make other changes in a health-care plan, such as increasing subsidies
to help low-income Americans purchase insurance. The Senate Finance Committee
bill, for example, proposed spending about $10.9 billion to reverse the cut and
instead give doctors a 0.5 percent increase in their Medicare payments in 2010.
Without that provision, the money can be used elsewhere in the bill.
Consequently,
Senator Debbie Stabenow (D-MI) has introduced the stand-alone physician payment
measure that would repeal the SGR formula, and the combined Senate health-care
overhaul bill would then implement a new system that more closely ties Medicare
physician payments to the quality of care the doctors deliver.
This
strategy of separating Medicare physician fees from the health-care overhaul
still may create problems, particularly in the House of Representatives where
Members are very concerned about the cost of the fix and paying for it. The Blue Dog Coalition, a group of fiscally
conservative House Democrats, has demanded either that changes to the physician
fee schedule be paid for or that a bill would be enacted that would make pay-as-you-go rules
statutory.
The
House health-care overhaul (HR 3200) includes a provision to
permanently change the way doctors are paid under Medicare, at a cost of about
$245 billion over the next 10 years. Senator Stabenow was unsure exactly what
her bill would cost but said the figure was in the same neighborhood - and it
would not be offset, thus adding to the deficit.
The
House has passed a statutory pay-as-you-go bill (HR 2920), but the Senate has made no move
to act on it. House Democratic leaders have pledged not to ask the House to
vote on any change to the Medicare physician fee issue unless the pay-as-you-go
bill is enacted or is attached to the physician fee measure. In other words, the House leadership has said
that statutory pay-as-you-go legislation will be enacted or that Congress
will find a way to pay for the physician payment fix but simply cannot try and
hide it outside of health reform legislation.
Nevertheless,
congressional leaders understand the importance of averting the scheduled
Medicare physician payment cuts. “Whether it is in or out or
separate, we are going to do a fix of one year or permanently,” House Majority Leader Steny Hoyer (D-MD) said
Wednesday, “That decision has been made.”
It is critical that every member of the Senate hear from physician
constituents urging passage of S. 1776. Visit the ASH Advocacy Center today to send an e-mail to
your Senators urging support for the bill.
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