With the U.S. Senate and most House members having left Washington for the holidays, the 27.4% cut in Medicare payments to doctors will almost certainly go into effect on January 1. Although it remains theoretically possible that Congress could return next week to reach a deal, the House and Senate are so dug into their sides that I don’t expect that to happen.
More likely, the SGR will be dealt with when Congress returns in January, at which point it is likely to enact a “fix” retroactive to January 1. Problem is, the Senate isn’t scheduled to return to Washington until January 23, the day when Medicare will have to start processing claims with the 27.4% cut. (Medicare by law can only hold them for 14 business days from the date of service.) Congress could decide to return earlier and find some other way to take action before the cuts have to be processed, but in the meantime physicians should prepare themselves for the possibility that the 27.4% cut will happen, at least for services provided during the first week of January.
It isn’t just physicians who are being left in the lurch, of course. The impasse means that payroll taxes will go up for just about everybody, and unemployment benefits will be cut off for many. And this isn’t the first time that this Congress has failed to do its job.
Roll Call reports that “the level of dysfunction that has characterized the 112th Congress may be unparalleled. Aside from passage of trade agreements in September and a handful of minor policy bills, virtually the only bills that have made it to President Barack Obama’s desk have either been appropriations measures, the most basic function of Congress, or emergency stopgap bills to avert government shutdowns or credit downgrades. And even those have come only after Congress took itself and the nation to the brink of collapse. The reasons for the dysfunction are varied, from gridlock in the closely divided Senate to Boehner’s increasing difficulty in managing the expectations and actions of his unruly conference. But regardless of the reason why, lawmakers acknowledge they have reached a new low.”
Is it any wonder that Gallup reports that this Congress is the least popular in history?
I know that the SGR cut will lead some ACP members to question the effectiveness of ACP’s advocacy, and I am always open to ideas on what we might do differently.
But here is how I see it. ACP has cajoled, lobbied, pressured, proposed and used every argument and ethical tactic we could think of to get Congress to do the right thing and eliminate the SGR. (The one tactic we will not use is to support a physician boycott or strike, a violation of ACP’s code of ethics.)
We offered specific ideas to end the SGR, stabilize payments, and transition to new models that recognize the value of internists' care. We even told Congress how to pay for it. We have built coalitions with other medical organizations, AARP, and other stakeholders. And this time, we decided we would not be pulled into helping Republicans or Democrats, House or Senate, get votes for another short term fix paid for by deeper cuts next time. That tired script hasn't worked before and won't work now.
What we can't do, that no one organization can do, is fix a broken Washington where compromise is considered a deadly sin, where partisanship and ideology trump common sense, where brinkmanship and gridlock is the norm. Only voters can do that by electing people committed to making the system work again.
Today’s question: How would you fix a broken Washington?