Debate Continues Over Long-Term Changes to Medicare Pay Formulas

Lawmakers' latest disagreement over long-term funding for Medicare physician reimbursements is now holding up a bill (HR 4213) that would extend unemployment benefits, CongressDaily reports (Cohn, CongressDaily, 5/13).

On April 15, Congress approved legislation (HR 4851) that would temporarily extend unemployment benefits, including subsidies to help purchase COBRA coverage, and delay a scheduled cut to Medicare physician payments until May 31 (California Healthline, 4/16).

Lawmakers are discussing a long-term extension of those benefits and a fix to the sustainable growth rate formula, which has scheduled annual cuts to Medicare reimbursements to physicians. Congress has offset the cuts each time.

Outlook for Payment Fix

A permanent Medicare physician reimbursement fix was approved by the House last year, but that legislation is not viable in the Senate because of new pay/go rules enacted in February. However, those rules included language that permits as much as $88.5 billion to be used to address the physician payment fix without offsets, CongressDaily reports.

House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) acknowledged the Senate's pay/go limitations but has voiced support for a "generous" fix, according to CongressDaily.

Still, a number of moderate senators -- including some Blue Dog Democrats -- are "chafing at being asked to vote for" a substantial physician payment fix, CongressDaily reports.

House Democrats are seeking to bring the unemployment extension to the floor next week. However, Senate Democrats are mixed on the extension and may not approve the current bill.

Last year, a bill that included a permanent fix to the Medicare physician pay formula received just 47 votes in the upper chamber (CongressDaily, 5/13).