The ACP Advocate Blog
by Bob Doherty
Friday, February 26, 2010
Jim Bunning throws doctors a curve ball
Last night, retiring Senator Jim Bunning (R-KY) single-handedly held up passage of legislation to stop a devastating Medicare payment cut that will go into effect on Sunday. Unless the Senate finds a way to clear the legislation this morning by a unanimous voice vote - considered unlikely because Bunning has stated that he will not withdraw his "hold" on the bill - starting next week, all Medicare claims submitted by physicians will be reduced by 21 percent.
Probably only for a few days, though, because I anticipate that Congress will come back next week and find another route to stop the cut and hold physicians and patients "harmless" (that is, to restore payments for the period when the cut was in effect). CMS may also hold up on processing claims for a few days to give Congress time to act. Still, even if this all comes together, it looks like the result will be another 30 day extension of current rates, meaning that Congress will have to revisit the issue again and do something to stop the next scheduled cut. And at some point, Congress has to figure out what to do about the underlying problem: an unworkable formula (SGR) that triggers cuts in Medicare payments whenever spending on physician and related services grows faster than the overall economy.
It isn't just physicians who are being held hostage to the Senate's dysfunction; the bill also includes an extension of jobless benefits and COBRA coverage for people who otherwise will lose their coverage along with their jobs, and many other popular provisions set to expire at the end of the week. (The House of Representatives has done its part by passing legislation to provide a 30 day extension of the expiring programs. It also has passed legislation to permanently repeal the SGR and replace it with a new formula to provide more stable updates going forward.)
Let me say this as clearly as I can. The continued dysfunction in the Senate is unacceptable. Temporary patches to the SGR are unacceptable. ACP has made it absolutely clear that the only acceptable outcome is permanent repeal of the SGR.
But the current dysfunction in the Senate endangers much more than patients' access to Medicare. It has put health care reform on life support. It has created an unprecedented loss of public confidence in government's capacity to do the right thing. It has led to an increasing degree of anger among the electorate, as more and more of us feel like channeling Howard Beale's "I'm mad as hell, and I'm not going to take it any more ..." rant from 1976's "Network."
Meanwhile, President Obama's bipartisan summit may have produced the ironic result of getting Democrats behind a strategy of enacting the bill without GOP support by using the "majority rules" reconciliation process. Mike Allen blogs in Politico's Playbook that Bloomberg news' headline "Obama Bipartisan Health Summit Clears Path to Party-Line Vote" pretty much says it all. I'll have more to say about the summit next week, but I think one of the President's greatest challenges will be to get the public behind completing the bill on a party-line vote, when confidence in Congress, understandably, is at a historically low point.
Today's question: What do you think physicians and patients should tell their Senators about the SGR?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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