House GOP's effort to repeal SGR takes aim at ACA's individual mandate

House Republicans have found another back-door way to attempt a partial dismantling of the Affordable Care Act. The lower chamber is expected to vote on legislation that would permanently repeal Medicare's sustainable growth-rate formula for physician payment, which might also include a provision to either repeal or delay the ACA's individual insurance mandate as a way to pay for the SGR fix. But as before, their efforts are certain to die in the Senate, making another temporary, not a permanent, SGR fix more likely as a March 31 deadline looms.

The House is likely to vote this week on the SGR Repeal and Medicare Provider and Payment Modernization Act of 2014, but 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. According to the 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 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 is not likely the path to solving the SGR problem.

“We know the Senate is not going to accept that,” Hobson said. Hobson also noted the condensed timeframe 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 SGR fix. 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.

Follow Jessica Zigmond on Twitter: @MHjzigmond