Congress Could Pursue a Permanent Medicare Physician Payment Fix

House and Senate leaders are discussing a permanent fix for Medicare's sustainable growth rate formula, lawmakers and aides said Wednesday, the Wall Street Journal reports (Peterson/Radnofsky, Wall Street Journal, 3/11).

Background

Congress over the years has passed a number of short-term delays to scheduled reductions to Medicare physician reimbursement rates called for by the SGR. Lawmakers in March 2014 approved a short-term delay to such reductions (California Healthline, 3/27/14).

A Congressional Budget Office report released in February found that bipartisan legislation (HR 4015, S 2000) proposed last year to permanently replace the SGR would cost $174.5 billion between fiscal years 2015 and 2025 (Ferris, The Hill, 3/11).

Physicians face about a 21% reduction in Medicare reimbursement rates unless Congress acts by April 1.

House Leaders Pushing for Permanent Fix

According to aides, House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) are looking for ways to implement a permanent fix before the temporary "doc fix" expires at the end of this month.

Boehner spokesperson Michael Steel said, "We are all aware of the looming SGR deadline, and members and staff from both leadership and the committees are naturally discussing a range of options" (Wall Street Journal, 3/11). A Democratic aide also confirmed the negotiations (Attias, CQ Roll Call, 3/11).

According to lobbyists following the discussions, negotiators are considering budget cuts to offset portions of a permanent fix's costs. In addition, a permanent SGR replacement package could include funding to extend CHIP, which is scheduled to expire on Oct. 1. According to the AP/San Francisco Chronicle, a four-year CHIP extension would cost around $10 billion (Fram, AP/San Francisco Chronicle, 3/11).

According to The Hill, House Majority Leader Kevin McCarthy (R-Calif.) in a memo to Congress on Wednesday told lawmakers to be ready for a potential vote on an SGR replacement bill when they return from recess. The memo did not offer any details on such a measure (Ferris, The Hill, 3/11).

According to the AP/Chronicle, it is uncertain whether Congress would pass an SGR replacement package that is not fully financed. Such a package could face opposition from Republicans who do not want to increase budget deficits, as well as Democrats who could object to Medicare cuts (AP/San Francisco Chronicle, 3/11).

Temporary Fix a Possibility

The House also could vote on a bill to implement another temporary fix during the last week of March, if needed, according to The Hill's "Floor Action" (Marcos, "Floor Action," The Hill, 3/11). A temporary fix would allow lawmakers extra time to work on a permanent SGR solution (AP/San Francisco Chronicle, 3/11).