Keeping the government running is the only major task before Congress during its four-week lame-duck session. That has some healthcare lobbyists hoping Capitol Hill and the White House will find time to settle some long-standing problems like permanently fixing the physician pay schedule.
Bet against that one. With published reports suggesting President Barack Obama later this week will announce plans to adopt some immigration reforms through executive order, the prospect is for continued gridlock and tons of drama. Then they'll agree to keep the lights on when current appropriation bills expire Dec. 11.
There's a “1-in-10 million” chance of a permanent repeal of the sustainable growth-rate formula passing during the lame-duck session, said Thomas Scully, CMS administrator under President George W. Bush who is now a lobbyist at Alston & Bird. “I'd be surprised if there's anything of significance that happens outside of” funding the federal government.
On the bright side, there is hope for people threatened by the Ebola outbreak in the West African nations of Guinea, Liberia and Sierra Leone. The Obama administration has requested a $6.2 billion aid package that includes money to prepare for future cases in the U.S.
Most political observers expect there to be broad consensus around approving the program, although the precise amount and how those dollars get spent will likely change as Congress scrutinizes the proposal.
There isn't much appetite for taking on other healthcare policy issues despite efforts by the American Medical Association and its allies like the GOP Doctors Caucus. They are pushing Congress to adopt a bipartisan bill that would permanently repeal and replace Medicare's sustainable growth-rate formula on physician pay.
But the roughly $140 billion cost over a decade remains the big stumbling block. If the current “doc fix”—the 17th so far—expires at the end of March without a replacement, physicians' pay would be cut by 21.2%.
Efforts to extend the popular Children's Health Insurance Program, which expires next Sept. 30, will also likely founder. Advocates, including the Medicaid and CHIP Payment and Access Commission, argue that leaving CHIP in limbo heading into next year could cause states to restrict eligibility for the program, which currently provides coverage to roughly 8 million lower-income kids.
Shifting CHIP beneficiaries to Obamacare exchange plans could create disruptions in coverage and care, advocates fret. But extending the program for four years, as proposed by retiring Sen. Jay Rockefeller (D-W.Va.), would cost nearly $90 billion.
Federally qualified community health centers, which also have received bipartisan support in the past, face the same funding cliff at the end of the fiscal year.
They'll lose $3.5 billion if Congress doesn't extend healthcare-reform-law levels of funding. Last month, more than 300 legislators from both parties signed a letter calling for an extension.
“A bipartisan coalition is coming together to address the health center funding issues,” said Dan Hawkins, policy director for the National Association of Community Health Centers. “Folks on both sides of the aisle recognize the seriousness of the problem.”
Yet with no imminent deadline on any of those issues and Republicans set to take control of both houses of Congress for the first time since 2006, neither party has much of an incentive to take up costly programs involving tens of billions of dollars during the lame-duck session.
Indeed, incumbent GOP senators will be preoccupied with distributing gavels and preparing a legislative agenda for January.
“Whatever they do in these four weeks on anything really has to be bipartisan and bicameral,” said Rick Pollack, the American Hospital Association's executive vice president for advocacy and public policy. “If there isn't a deadline staring at them in this environment, it makes it difficult for something to be addressed.”
Republican leaders also will face pressure from their right flank to hold off on taking up major healthcare policy issues in the lame-duck session, when Senate Democrats still would be able to share in writing the bills. Nina Owcharenko and Robert Moffit, healthcare policy analysts at the conservative Heritage Foundation, warned against jamming through deals on SGR and CHIP during the short session in a recent column.
“These are serious health policy questions that need to be untangled,” Owcharenko said. “I don't think a lame-duck Congress, where they throw everything into a mixing bowl and have at it, is really a prudent approach.”
