Monday, December 19, 2011

An Unwelcome Holiday Tradition

Waiting until the last moment for Congress to stop the next Medicare SGR cut has become an established holiday tradition, right along with trimming a Christmas tree or lighting a Menorah. This December tradition, though, is anything but welcome. During this supposed season of joy, why must doctors and patients be left waiting to know whether Congress will enact legislation in time to prevent a January 1 cut of more than 27 percent?

Last week, I blogged that “the odds still favor an agreement to stop the 27.4% SGR cut, although the issue may not be decided until after Christmas—just days before it is scheduled to go into effect.” Now, I am not optimistic at all. Over the weekend, Congress navigated itself into another partisan dead end, making it much more likely—with each passing day—that no agreement will be reached in time to avert the 27.4% New Year cut.

Here is what happened.

Last week the House passed a bill, as part of a broader “extenders” package, to prevent the Medicare cuts for two years, replacing them with a small positive update. The House bill, though, included budget offsets and policy riders that were unacceptable to the Senate and White House. On Saturday, the Senate passed a short-term patch, as part of its extenders bill, which would have extended current Medicare payment rates for only two months. Today, the leadership of the House of Representatives stated that the Senate bill is unacceptable, and that it instead would seek an agreement on a year-long extension of Medicare payment rates and other expiring provisions. Yet the House has not presented a plan or process to resolve its differences with the Senate.

If the Senate bill is voted down tonight by the House, as is now expected, there is no clear path forward that would allow Congress to act before the 27.4% cut goes into effect on January 1. The Senate has already recessed for the year, and Majority Leader Reid has vowed not to bring it back to negotiate with the House unless the House agrees to the Senate’s two-month extension. If he doesn’t yield, and Speaker John Boehner doesn’t yield on the House’s insistence that the House and Senate agree to a new plan, there is no viable way to prevent the 27.4% cut before it goes into effect on January 1.

As it has done in past years, Congress could return in January and try to enact a “fix” that is retroactive to January 1, with CMS holding claims (as it is required to do for 14 business days anyway) in the meantime. But with the Senate not scheduled to return to Washington until January 23, this allows no time for Congress to enact a retroactive fix before CMS would have to instruct its carriers to begin paying at the reduced rate, on or around the same day that the Senate returns. Beyond that date, CMS would have to begin paying interest on any delayed claims.

Sure, Congress could return sooner in January, or better yet, there may be some way for it to find a solution prior to January 1. But I wouldn’t bet on it.

ACP, for its part, released a statement today blasting Congress for the disarray and dysfunction that is jeopardizing care for millions.

Congress’ failing to stop the SGR cut is the equivalent of the proverbial coal in your stocking, or the Grinch who stopped Christmas from coming. Only unlike the Grinch, there seems little chance that Congress’ “small heart will grow three sizes larger” so that it brings back what the SGR has taken from doctors and their patients.

Today’s questions: What will you say to your Representative or Senators if Congress allows the 27.4% SGR cut go into effect? What will you say to your patients?


Steve Lucas said...

“In the race between principles and politics, principles will always loose.”

Steve Lucas

Harrison said...

One thing that is worthwhile to do is to point out what is broken.
The Congress controlled by the Democrats with Sen Reid and Speaker Pelosi were reasonably productive in producing legislation and were also reasonably popular. They had approval ratings in the low 40% range. They moved legislation through, and that legislation softened an economic downturn that was as bad as the one that led to the Great Depression.
Then came 2010.
The Republican control of the House is the problem.
It isn't that their ideas are bad. It is that they are unwilling to compromise.

The payroll tax cut and the 2 month SGR fix that were passed overwhelmingly by the Senate was a compromise bill. The Senate Democrats had favored a surtax on millionaires to pay for a one year extension of the payroll tax cut. The House Republicans wanted to do it with basic changes to Unemployment benefits, and with higher premiums to some Medicare beneficiaries, and with selling more broadband spectrum.
The two month compromise included a demand that the President make a decision on the Keystone Pipeline.
It was negotiated by Republicans and Democrats, and Speaker Boehner had given his approval of this process.

In this issue there is not 'plenty of blame' to go around.
There is one negotiator who is acting in bad faith. That is Speaker Boehner and the House Republicans.

If I am wrong on these facts I am willing to bend from this position.
But as I see it, the blame is quite clear.
On this issue.

As for political discourse being broken in general...I think we need to establish facts about issues and find points of agreement.
I'm afraid that is missing in Washington.
In addition to ideological divisions, I think there are personal animosities that are getting in the way.

I don't know how to overcome that.