More on the half full side:
What the House did defied expectations—passing expensive, complicated, and one might have expected, controversial legislation making huge changes in the popular Medicare program, by a lopsided and bipartisan majority of 392-37. The Washington Post reports that such a “Kumbaya” moment, when the two political parties vote together to get legislation passed, is exceedingly rare in “our modern, polarized era.” Why did the SGR bill get so much bipartisan support? For one thing, it was directly based on a bipartisan and bicameral bill that both parties and both chambers had agreed to last year, only to falter on the question of how to pay for it. But because there already was agreement on the underlying policies, the House did not have to start from scratch this year on crafting a bill that both parties could support.
What really put it over the top, though, was the decision by Speaker John Boehner and ranking Democrat Nancy Pelosi to hash out an agreement on how to partially pay for it—partially being the operative word. Had either insisted that it be fully paid for, it would have been near impossible to agree on enough budget savings that both parties could agree on.
Like all compromises, the agreement had some things that both Speaker Boehner and Minority Leader Pelosi could take back as “wins” to their respective caucuses. Boehner was able to talk up “entitlement reforms” in the bill that over time will require higher income beneficiaries to pay more for Medicare Parts B and D and apply a $250 deductible to Medigap plans. Pelosi was able to talk up provisions in the bill that provide permanent funding for a program that lowers Medicare premiums for poorer beneficiaries, and two years of funding for the Children’s Health Insurance Program, Community Health Centers, the National Health Service Corps, and GME Teaching Health Centers.
The bill also had unprecedented support from stakeholders of all varieties, from more than 750 physician membership organizations (including ACP), from hospitals, from nurses, from consumer groups, from nursing homes, and many more.
Following the House vote, ACP issued a statement congratulating Speaker Boehner and Minority Leader Pelosi, along with the 392 representatives who voted for it, and urging the Senate to pass it before recessing today.
Now, for the glass half empty side. Just like it takes two to tango, it takes both chambers of Congress to pass a law. The House did its part, the Senate did not. Instead, the Senate recessed at 3:30 this morning without taking any action on the House bill. Both Majority Leader McConnell and Minority Leader Reid promised that the bill would be taken up “quickly” after the Senate’s return on April 13, but there is reason for physicians to be concerned that they will not act in time to avert a 21% SGR cut for services provided on or after April 1. Because Medicare holds claims for 10 business days before paying them, the 21% SGR cut will begin to be applied on April 15 for physician services provided to Medicare enrollees on and after April 1. But because the Senate will not return from the recess until April 13, it will have fewer than 48 hours to enact H.R. 2 before the 21% cut will begin to directly affect payments to physicians for services provided to Medicare enrollees.
The cut would then continue until the House and Senate both pass identical bills to stop the cut and repeal the SGR, which could take days, maybe longer. If, on the other hand, the Senate joins the House and enacts H.R. 2 immediately upon its return, and without making changes in the bill from the House-passed version that would delay enactment, Congress can still repeal the SGR in time to stop the 21% cut from actually affecting payments to physicians.
The Senate could have prevented all of this uncertainty if it had just passed the House bill before taking two weeks off, but it didn't. ACP, in a release issued a few hours ago, expressed great disappointment with the Senate’s failure to take up the House bill and advised them that physicians and patients would hold their Senators accountable.
For that, we will need every physician to help us, by calling your Senators. Insist that they commit to voting for H.R. 2 immediately upon return on April 13 from the recess, and before the cut begins to show up in your payments fewer than two days later. They will be heavily lobbied from the right and the left by groups that don’t like some of the policies in the bill, and their efforts need to be countered by the physician community.
Otherwise, we will end up with an empty glass, drained by empty SGR repeal promises made by a Congress that, once again, will have failed to deliver the votes that were needed.
Today’s question: What will you do to hold your Senators accountable?