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 Hundreds of thousands of doctors who participate in
traditional Medicare face a 24 percent pay cut on April 1, as part
of a 1990s initiative to restrain federal spending on the government
healthcare program, which today serves nearly 50 million elderly and
disabled people.
Doctors thought they would see a permanent fix this year after
Republicans and Democrats in the House of Representatives and Senate
agreed on a policy to replace the payment formula, known as the
sustainable growth rate or SGR, according to lobbyists,
congressional aides and analysts.
But efforts to seal the deal broke down over how to fund its $138
billion cost over the next decade, and the doc fix appeared to be in
danger of political oblivion as Republicans in the House and Senate
pursued legislation that would pay for a solution with money from
President Barack Obama's signature healthcare reform law.
The sudden partisan character of the doc fix debate brought an
unusual public rebuke from the American Medical Association, one of
the most powerful lobby groups, representing 225,000 physicians.
"I am writing to profess our profound disappointment that a strong
bipartisan, bicameral effort to repeal the Medicare sustainable
growth rate has become a victim of partisan approaches," Dr. James
Madara, AMA's chief executive, said in a Thursday letter to House
Speaker John Boehner and House Democratic leader Nancy Pelosi.
"We renew our call for all parties to engage in good faith,
bipartisan efforts to address the budgetary implications of this
bill and enact it. We stand ready to work with you in this
endeavor."
Other physician groups also expressed their displeasure over the
partisan turn.
"It's a sad state of affairs," said Dr. Thomas Barber, a lobbyist
for the American Academy of Orthopedic Surgeons, which represents
16,000 physicians.
"To see something that was supported by both parties get shanghaied
into the partisan politics of the day is very frustrating," he said.
NOVEMBER ELECTION
Congressional aides described the Republican legislation as a signal
that a months-long push for a permanent, bipartisan doc fix is
unlikely as the political calendar moves toward the November
election. Instead, they said doctors would probably see a temporary
patch of nine months or more that would avoid the April 1 pay cut
and postpone a permanent solution into the next Congress, which
takes office in January 2015.
Lobbyists said that could mean starting the process over, especially
if a Republican Senate victory in November creates a new political
dynamic between Congress and the Obama White House.
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Analysts said it also eliminates an opportunity to
move traditional Medicare away from its costly fee-for-service
structure. Republicans and Democrats agreed to replace the SGR with
policies that call for Medicare doctors to accept new performance
standards or participate in alternative care models designed to
improve service while lowering costs in exchange for avoiding pay
cuts.
House Republicans are poised for a Friday vote on a bill that would
find the money by delaying the individual mandate penalty in
President Barack Obama's healthcare law for five years, an action
opposed by the White House and its Democratic allies in Congress.
The bill advanced on Thursday on a procedural vote, largely along
party lines.
Meanwhile, Republican Senators Orrin Hatch and John Cornyn were
joined by Senate Republican Leader Mitch McConnell on a bill that
would repeal the individual mandate altogether to generate money for
a permanent doc fix. Lobbyists said the bipartisan
momentum ended in the early weeks of 2014, after oversight committee
chairmen from both congressional chambers struck a deal on policy
language that they incorporated into legislation.
Behind-the-scenes efforts to reach a deal on money quickly ran
aground, with Republicans demanding that the money come from
entitlement reforms to Medicare and the Medicaid healthcare program
for the poor, and Democrats pushing for hypothetical savings from
the wars in Iraq and Afghanistan.
The AMA, which has led more than 600 other physician groups in a
lobbying effort to secure a permanent doc fix, says it is still
hoping for a permanent solution this year. Analysts say some doctor
groups are pressing lawmakers to agree to a shorter patch of only a
months to sustain the opportunity for dialogue.
The AMA says there have been 16 temporary SGR patches so far,
costing taxpayers $154 billion. Securing an agreement on the doc fix
is one of the association's highest priorities.
(Editing by Mohammad Zargham and Steve
Orlofsky)
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