Most health policy observers don't expect the bipartisan bonhomie in Congress surrounding last week's enactment of the Medicare physician payment-reform package to last.
The divide between Republicans and Democrats over the Affordable Care Act remains as stark as ever, and there is a vast gulf between the budget blueprints proposed by President Barack Obama and the Republican-controlled Congress. In addition, the pending King v. Burwell lawsuit before the U.S. Supreme Court—which could erase premium subsidies through the federal exchange in up to 37 states and sow chaos in the insurance market—will hang over any healthcare policy discussions. A ruling in that case is expected by the end of June.
The doc-fix legislation was a triumph of classic closed-door dealmaking between House Speaker John Boehner and Minority Leader Nancy Pelosi. Both Democrats and Republicans were upset about certain provisions of that package. But in the end, the overwhelming majority held their noses and voted aye. Obama signed the bill Thursday, ending more than a decade of short-term fixes and averting a 21.2% cut in payments to doctors.
Larry Jacobs, a healthcare politics expert at the University of Minnesota, said the payment-reform deal was possible because Medicare enjoys tremendous support among powerful healthcare industry groups and seniors, who vote in large numbers.
Tom Scully, who served as CMS administrator under President George W. Bush, also thinks that the circumstances encouraging harmony on the doc fix were unique. “At this point they didn't have much choice,” said Scully, now a general partner with the private-equity firm Welsh, Carson, Anderson & Stowe. “It was driving stupid legislation year after year.”