But Julius Hobson, a former lobbyist for the American Medical Association who now serves as a senior policy adviser at Polsinelli Shughart, said the deal's healthcare cuts were “low-hanging fruit,” which consequently pose more serious threats in the coming weeks and months.
“The problem I see in those offsets is connected to the long-term problem: If we don't get a permanent fix in the grand deal, or if there will be many grand deals and you don't do a doc fix, where do you get the offsets for another patch?” Hobson said.
Congress needed to find only about $25 billion to temporarily fix the SGR, so they didn't have “to go big” this time around, said Eric Zimmerman, a partner with McDermott Will & Emery in Washington. Hospitals, he said, were spared cuts to bad debt, graduate medical education, and evaluation and management services. They might not be so lucky in the next go-around.
“For the president to get more room on the debt limit, chances are Republicans are going to want to see commensurate spending reductions, and that is going to require substantial changes to Medicare and Medicaid—and Congress will have to look for big dollars on those programs.”
A broader debate over entitlement reform would provide a forum to address a full repeal of the SGR. Republican physician-lawmakers are hopeful that substantive discussions on this issue will happen in 2013. Rep. Charles Boustany (R-La.), who told Modern Healthcare he voted against the fiscal cliff bill because of tax issues, said the House Ways and Means Health Subcommittee is making progress on draft legislation to address the SGR. “We're going to push very hard to get a bill,” he said, although he did not suggest how to pay for it. “Pay-fors are all up for discussion,” he added.
Rep. Michael Burgess (R-Texas) said he voted against the bill because postponing the sequester broke a promise lawmakers made to the American people when Congress created the mechanism, which was included in the 2011 Budget Control Act to compel lawmakers to reduce spending.
Burgess, a physician, also said he thinks there will be serious talks about repealing the SGR this year. He doesn't want the solution to force physicians into particular delivery models.
“There has to be a way to allow all of the different practice parameters to allow them to continue and flourish, in my opinion, in whatever is the follow-on from the SGR,” Burgess said. “That is to say, it wouldn't be right to make everyone practice in an ACO because there are some places in the country where an ACO wouldn't work.”