Congress doesn't return from spring break until April 13, but advocates of repealing Medicare's sustainable growth-rate formula aren't taking any time off. Instead, they continue to press their agendas with senators and their key staffers during the recess.
The House last Thursday passed the repeal package crafted by House Speaker John Boehner and Minority Leader Nancy Pelosi on an overwhelming, bipartisan vote. But the Senate failed to take action before leaving town for its spring recess.
The Senate is expected to deal with the legislation when it reconvenes. But supporters of permanently repealing the SGR, which has bedeviled Congress for more than a decade, aren't taking any chances.
The American Medical Association is pressing supporters to call or write their senators during the break. Their message: “Now the Senate must act. This formula is hurting physicians and patients by annually threatening payment cuts that will impact a patients' choice of physician and access to the care they need.”
Similarly, the American Hospital Association, which represents not-for-profit facilities, sent out a letter to all of its members Tuesday urging them to contact their senators in support of the repeal package. The AHA and other hospital groups are backing the legislation despite nearly $20 billion in anticipated funding cuts that they'll face over a decade.
The repeal package also includes $7.2 billion in funding for community health centers. Supporters of that provision logged 19,000 calls to congressional offices in the run-up to the House vote, according to the National Association for Community Health Centers. That effort will ramp up again when a Senate vote nears.
Some advocates are using the break to still push for changes to the package. The AARP has raised concerns that too much of the repeal package is paid for by raising costs for Medicare beneficiaries. Nearly half of the $73 billion in spending reductions is achieved by hiking premiums for Medicare beneficiaries with incomes of at least $133,000.
The AARP is floating a couple of changes that would ameliorate its concerns. The House bill contains a two-year extension of a program that allows for exceptions to a cap on the amount of expenditures for physical therapy a beneficiary can receive. The senior advocacy group would like to see that program made permanent.
In addition, the legislation makes permanent a program that provides premiums assistance to poor Medicare beneficiaries, a change supported by the AARP. But the group would like to see the upper income threshold for that program increased from 135% to 150% of the federal poverty level.
Ariel Gonzalez, AARP's director of health and family advocacy, points out that other healthcare interests that are likely to benefit from the permanent repeal of SGR, such as pharmaceutical companies and health plans, aren't facing any financial hit. “AARP would have been more comfortable if other stakeholders had been asked to step up and contribute to this package,” Gonzalez said.
Children's healthcare advocates also are still pushing for a four-year extension of the Children's Health Insurance Program instead of the two-year extension included in the House bill. Bruce Lesley, president of First Focus, said they are talking with Senate staff about the possibility of a “deficit neutral” way of adding an additional two years to the program. That would potentially be accomplished by moderating the bill's increase in the share of CHIP costs covered by the federal government. Under the House bill, some states would have the entire cost of the CHIP program covered by federal dollars.
But most healthcare policy watchers don't expect there to be much interest in re-opening the package. That's in part because then it would need to return to the House, which blessed the current deal with a rare show of bipartisanship. Any changes could jeopardize that accord.
“With respect to CHIP, we would all like four years,” said Tom Nickels, the AHA's senior vice president for federal relations. “But to reopen the whole package I think is a big mistake and I don't see it happening.”
