The prospects for a permanent doc fix prior to the March 31 deadline are looking increasingly remote. No agreement has been reached on how to pay for a permanent repeal and replacement of Medicare's unpopular sustainable growth-rate formula
for physician payments.
The House plans to vote for a patch this week, according to a source familiar with discussions, although it remains uncertain how long a period it will cover. Previously, the House approved a Republican-sponsored bill to pay for repeal by delaying the individual mandate for five years—a nonstarter for Democrats. The Congressional Budget Office estimated that the House bill would cost $138 billion over 10 years and result in 13 million fewer people having health insurance coverage.
The Senate has yet to make clear how it intends to pay for a repeal. But a key staffer for Senate Finance chairman Ron Wyden (D-Ore.) indicated last week that he's “very open
” to tapping Overseas Contingency Operations funding—which currently pays for military operations—to cover the cost. The CBO has estimated that the Senate version of the bill, which includes extensions of several Medicare payment programs, would cost $180 billion over 10 years.
“We're still not sure about the time,” Ken Willis, a spokesman for Wyden's office, said in an e-mail. “The floor action this week—Ukraine and unemployment—may push SGR into next week. Wyden is still focused on full repeal and replacement of the SGR with bipartisan support.”
Willis declined to offer any specifics about where funding for the Senate version might come from. But if Wyden opts to tap OCO funding, that legislation isn't expected to draw GOP support. And there remains skepticism on Capitol Hill about whether he can corral the votes from his own Democratic caucus to pass such a plan. That raises the question of whether the Senate will even hold a vote on a permanent repeal bill prior to the deadline.
So what are the odds at this point of the two legislative bodies coming together with a permanent fix before the clock runs out on March 31?
“None. Zero. Nada. Zilch,” is how one GOP Senate staffer put it. “There's no evidence that there's been any work on coming together.”
If that's accurate, the fallback will be yet another patch to keep the cuts to doctors—anticipated to be 24% in 2014—from being enacted.
Sen. Orrin Hatch (R-Utah), the ranking minority member of the Senate Finance Committee, decried such a possibility during a floor speech this month. “This perverse annual dark-of-night ritual has to stop,” Hatch said. ”Seniors and physicians understand that.”
Rep. Michael Burgess (R-Texas) criticized the American Medical Association for not doing more to push the issue forward. "I would have thought that the AMA, with its vaunted lobbying organization, would have been burning up the phone lines over in the Senate," Burgess said. "They need to be putting pressure on the Senate."Follow Paul Demko on Twitter: @MHpdemko