The SGR Repeal and Medicare Provider Payment Modernization Act passed 238-181 and picked up support from 12 Democrats. Though cheered by House Republicans, the legislation is viewed by Democrats, policy analysts and healthcare providers as purely a political move that is not likely to go anywhere beyond the House floor.
“We're dismayed that Congress sabotaged their own work by linking legislation to unrelated, ideological issues—particularly in light of the nearly universal opposition to such action from patients, insurers and the medical community,” Dr. Reid Blackwelder, president of the American Academy of Family Physicians, said in a statement reacting to the vote.
Even the conservative Heritage Foundation did not support Friday's House vote. “If you are going to have a permanent repeal, which incurs permanent costs, you need permanent savings to offset those costs,” Robert Moffit, a senior fellow at Heritage, said in a statement.
Senate Finance Committee Chairman Ron Wyden, who introduced a version of the SGR repeal this week, said he is committed to sound, sensible policy over politics.
The Oregon Democrat also cautioned that hospitals, home health providers, drug companies and skilled-nursing facilities will once again be at risk if Congress doesn't find approve a permanent SGR repeal. “Make no mistake about it: Those providers are going to be the ones who pay for yet another patch,” Wyden said on the Senate floor.
The bill that Wyden introduced this week—the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014—includes the compromise agreement from the Senate Finance, House Ways and Means and House Energy and Commerce committees to repeal and replace the SGR, as well as the extension of certain Medicare programs that are expiring.
It does not, however, include a way to pay for these provisions. Meanwhile, the House bill that passed on Friday includes the compromise agreement on SGR, no language on the Medicare extenders and the dead-on-arrival delay in the ACA's individual mandate to pay for it.
“For me, the positive side is the House has done something,” said Julius Hobson, a senior policy adviser at law firm Polsinelli and a former lobbyist for the American Medical Association. “And when they get back from recess, the Senate will attempt to do something. It may heighten talks between the House and Senate, and that's my hope.”
But others expressed more frustration than hope, given that lawmakers still are not talking seriously about how to pay for repealing the SGR, which the CBO estimates will cost $138.4 billion over 10 years. This week, the bipartisan Committee for a Responsible Federal Budget released a statement that criticized House Republicans for trying to pay for a permanent repeal of the SGR with a temporary delay of the individual mandate's penalties, which the nonpartisan fiscal watchdog group said will only add to long-term deficits.
The organization also criticized House Democrats for proposing “phantom war savings” as a way to pay for the overhaul and the Senate for proposing none. The “phantom war savings” refers to funding for the Global War on Terrorism/Overseas Contingency Operations, most commonly referred to in Washington as “OCO funds.” Congress provided about $92 billion in OCO funding for 2014 and none for subsequent years, according to the CBO.
“There are ways to look at a package of things, from expanded means-testing to rationalizing co-payments to reforming Medigap plans,” said Maya MacGuineas, president of the Committee for a Responsible Federal Budget.