It remains unclear if the GOP lawmakers will attach a provision to repeal the individual mandate or delay it by several years, as one news report suggested. Earlier this week, the House voted 250-160 to delay the ACA's individual mandate for a year. The bill from Rep. Lynn Jenkins (R-Kan.) picked up support from 27 Democrats.
According to the nonpartisan Congressional Budget Office, a one-year delay of the individual mandate would save about $9 billion over 10 years. A permanent repeal of Medicare's SGR, meanwhile, would cost about $138 billion over 10 years.
Julius Hobson, a senior policy adviser at the law firm Polsinelli and former lobbyist for the American Medical Association, said this approach, using a $9 billion savings to fund a $138 billion cost, is not likely the path to solving the SGR problem, which has plagued lawmakers and Medicare-participating physicians for more than a decade.
“We know the Senate is not going to accept that,” Hobson said, referring to the repeal or delay of the ACA's mandate. “If they do this, it moves the policy of the doc fix another step forward,” he added. “It does not, however, mean we're a step forward to a final solution.”
Hobson also noted the condensed time frame that lawmakers now have, given that a temporary patch to the SGR ends March 31 and Congress will adjourn for a weeklong recess during the week of March 17.
All of this points to the possibility of another temporary fix until congressional leaders can reach agreement on how to pay for the cost of repealing the SGR. The CMS could hold payments to providers for roughly two weeks after March 31, he noted, which would essentially buy lawmakers more time to find a solution.
“One of the things about this week is that the negotiations have been kept very quiet—no leaks,” Hobson said of the SGR discussions on Capitol Hill. “It would suggest they have not made a lot of progress.”