Reform Update: Docs irate over 'doc fix' patch; fight shifts to Senate

(Story updated with additional comment at 5:40 p.m. ET.)

Doctors are trying to stoke a rebellion against the doc fix.

A one-year extension of the doc-fix patch passed the House by voice vote Thursday, and so efforts to derail the measure now move to the Senate, where Senate Majority Leader Harry Reid (D-Nev.) has reportedly scheduled a vote for Monday.

The American Medical Association issued a statement from President Dr. Ardis Dee Hoven saying the association “is extremely disappointed in today's House action to give up on SGR repeal. There was bipartisan, bicameral support for reform this year, yet too many in Congress lacked the courage and wherewithal to permanently fix Medicare to improve care for patients and provide greater certainty for physician practices. Congressional leadership had to resort to trickery to pass an SGR patch that was opposed by physicians.”

Dr. Charles Mick, an orthopedic surgeon from Northampton, Mass., and a past president of the North American Spine Society, expressed disappointment that congressional leaders once again opted for a patch. “All of us had been very optimistic that this was the best chance in many years for a permanent fix to the SGR problem,” he said.

Now that the House has acted, the chances of heading off the deal appear remote. But Mick is not giving up hope. “We will be putting pressure on the Senate to hopefully come up with a proposal,” he said. “Whether that will occur or not we don't know.”

New Finance Chairman Ron Wyden (D-Ore.) had issued a statement when the doc-fix deal initially surfaced Wednesday, blasting the patch. “My choice is to end the status quo in Medicare by permanently repealing and replacing the SGR,” Wyden said. “There is no reason to wait.”

Most observers say Wyden will still attempt to go through the motions of passing a permanent fix bill in the coming days. Staff from his office have indicated that he is “very open” to using Overseas Contingency Operations funding to cover the roughly $180 billion cost over a decade.

But with a deal already cooked between House Speaker John Boehner and Senate Majority Leader Harry Reid—and seemingly no stomach for reopening the issue on the House side—that means Wyden will have to acquiesce.

Joseph Antos, a healthcare policy expert at the conservative American Enterprise Institute, suggests that despite their current opposition, doctors will accept it as the best deal they could get under the circumstances. “Of course they're going to complain, because it doesn't just hand them money,” Antos said. “But they have nothing to complain about.”

Boehner on Wednesday announced that a deal had been reached to enact a one-year patch to replace Medicare's unpopular sustainable growth-rate formula for physician payments. That would stave off a potential 24% cut in payment to doctors starting April 1.

Rumblings immediately surfaced on Capitol Hill that docs weren't too pleased with the prospect of a 17th consecutive patch for the SGR formula. But most observers expected them to grudgingly go along with the pact to forestall any chance that no deal would get done by the deadline.

“It's a hard position for them,” said Dean Rosen, a partner with the lobbying firm Mehlman Vogel Castagnetti and a former top GOP staffer on healthcare issues. “They don't want to be ungrateful and say, 'Thank you for financing this 24 % cut, but we're not for this.' ”

But that popular perception proved misguided. On Wednesday evening, the AMA issued a statement urging House members to vote against the deal when it came up for an expected vote Thursday. That was followed by a letter from the AMA and dozens of allied groups to Boehner and House Minority Leader Nancy Pelosi laying out their opposition to the measure.

“Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary provider payment reductions to maintain a corrosive policy that essentially every member of Congress says should be scrapped,” it read.

But that opposition did little to halt the bill's progress in the House. Despite discord in Republican ranks that initially delayed the vote, the measure was hurriedly passed on a voice vote with no roll call taken, a technique used to squelch any possible derailment efforts.

Since Jan. 1, 45% of individuals buying coverage through eHealth—the country's most popular private, online marketplace for health insurance—have been between ages 18 and 34. That's up from 39% of customers who fell into that demographic block during the fourth quarter of 2013. In addition, more than half of eHealth customers since Jan. 1 reported that they previously lacked insurance coverage. That's up from just 34% during the last three months of 2013.

Premiums for plans purchased on eHealth also have decreased in 2014. Since Jan. 1, the average premium for an individual plan decreased by 10%, to $261. For family plans, the decrease was 7%, with an average monthly premium of $654. Those figures are still significantly higher than the cost of plans purchased through eHealth prior to the coverage requirements of the Patient Protection and Affordable Care Act.

Those trends bode well for the demographic profiles of the state and federal exchanges, which are expected to mimic enrollment patterns in private exchanges.

Health insurance companies spent nearly $450 million on advertising during the fourth quarter of 2013, according to an analysis by Kantar Media. That represents a 25% spike over the comparable period in 2012. While not all of that increase can be attributed to the Patient Protection and Affordable Care Act—the period also included key Medicare enrollment deadlines—the first open enrollment period for Obamacare certainly played a significant role.

Follow Paul Demko on Twitter: @MHpdemko