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Late News: Shutdown strife
Analysts look at healthcare issues beyond reform

By Jessica Zigmond
Posted: September 28, 2013 - 12:01 am ET

As Congress remains paralyzed over a short-term spending bill to fund the government after Sept. 30, analysts are looking ahead at key health policy issues other than the healthcare reform law that have taken a back seat during the spending fights and at how, where and when they might resurface.

On Friday, President Barack Obama called on House Republicans to approve a bill to avert a government shutdown after the Senate passed a $986 billion spending measure that would keep the government operating through Nov. 15. Senate Democrats stripped language from an earlier House bill that would have defunded the Patient Protection and Affordable Care Act. The president said the state health insurance exchanges would go ahead and enroll people even if there were a government shutdown.

But House Speaker John Boehner (R-Ohio) said last week that it's unlikely his Republican majority will accept the Senate bill, making a government shutdown starting Oct. 1 a real possibility. Beyond that, House leaders have promised to pass legislation raising the nation's debt ceiling that would include other measures opposed by Democrats that they say will curb spending and spur economic growth, such as a one-year delay in the ACA and construction of the controversial Keystone oil pipeline.

Experts worry these fiscal fights may delay or derail progress on other important issues affecting healthcare providers and industry groups. One issue is the bipartisan push to repeal Medicare's sustainable growth-rate formula for physician payment, which the House Energy and Commerce and Ways and Means Committees have worked on this year. That culminated in an SGR repeal bill that the Energy and Commerce Committee passed in the summer, which lacked any funding provisions. Another big set of issues relate to the proposed restructuring of Medicare and Medicaid.

“Because there are no areas of compromise, there is a lot of concern that permanent SGR repeal might be pushed off somewhere down the road until Congress can come together on these larger issues of importance,” said Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association.

Eric Zimmerman, a partner with McDermott Will and Emery in Washington, predicted that one of the big spending bills, either the continuing resolution or the debt limit bill or an omnibus budget bill, would be the vehicle for SGR, Medicare solvency extenders and other deficit-reduction measures.

Congress could take a similar approach to the repeal of the ACA's 2.3% excise tax on medical device sales, which has bipartisan support in both chambers, by including it either in a larger budget package or as part of a tax reform package, said Darrell McKigney, vice president for the Farragut Square Group, a healthcare strategy firm. Last year, the House passed legislation to repeal the tax, which raises about $30 billion over 10 years to help fund the ACA's subsidies and other features.

Experts say healthcare providers will have to closely watch the budget negotiations because their heads may end up on the chopping block. “Providers have to stay on the alert,” McKigney said. “They are the fastest growing part of the budget.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

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