Legislation to 鈥渇ix鈥� Medicare鈥檚 physician payment formula has stalled in the Senate, just days after Majority Leader Harry Reid, D-Nev., announced his intent to fast-track聽the measure.
The bill would eliminate a 12-year-old formula that reduces Medicare payments to doctors when their costs exceed budget targets. Congress has stepped in to block the cuts in seven of those years.
The current which was introduced last week by Sen. Debbie Stabenow, D-Mich., would do away with the formula and the scheduled pay cuts. Because these changes come with an estimated cost of $250 billion to the Medicare program and no off-sets, the bill has riled up budget hawks 鈥� both Republicans and Democrats 鈥� who say they will oppose the legislation until lawmakers find a way to pay for it.
Reid had announced last week that the Senate would hold a procedural vote on the measure Monday, but he backed away from that as he faced growing opposition on the financing. He continued discussions on the issue Tuesday but no new vote schedule was announced.
Stabenow argued at a press conference today that in previous years Congress did not make specific provisions to pay for limiting the cuts in payments to doctors. 鈥淭his year, let鈥檚 agree, we鈥檙e not going to move forward with these kinds of drastic cuts鈥� in physician pay, she said, dismissing the notion that the legislation needs to identify a way to cover its costs. 鈥淚 wanna get this fixed.鈥�
It鈥檚 an issue that has plagued physicians and patient advocates since 1997. At that time, Congress, in an attempt to curb the deficit, set up the so-called sustainable growth rate (SGR) formula to automatically reduce Medicare payments to doctors when spending on such reimbursements increases faster than the gross national product.
Over the years, physician groups have argued that the lower rates could lead doctors to accept fewer Medicare beneficiaries. And both parties have, at different times, supported temporary fixes they haven鈥檛 been paid for.
The American Medical Association says the rise in spending on physicians is often due to forces beyond their control, such as growing numbers of patients and an increasing preference to receive treatments in an office setting rather than at a hospital. The group has hard聽for Congress to block cuts in the past, and more recently, to scrap the entire formula.
In the House, lawmakers included a 鈥減ay fix,鈥� as doctors call it, in their broader health care reform legislation. But Senate Democrats want to treat it as a separate measure in order to reduce the cost estimate of their overhaul measure.
The president of the AMA, Dr. J. James Rohack, joining Stabenow at Tuesday鈥檚 press conference, said his group 鈥渆nthusiastically鈥� supports the new legislation. 鈥淭his bill is very important to the future of the Medicare program,鈥� he said.
But, when asked repeatedly whether the passage of the Medicare payment bill would guarantee the AMA鈥檚 support of the broader reform efforts, Rohack dodged the questions, saying 鈥淲e haven鈥檛 seen the Senate bill.鈥�
Norbert Ryan, a retired vice admiral in the Navy who now leads the Military Officers Association of America, also joined the press conference. Tricare, the federal insurance program for members of the military and their families, pays physicians based on Medicare rates. Ryan said pay cuts for doctors could leave troops 鈥渨orrying as they go into combat [whether] their sick child is going to be able to see a doctor.鈥�
An AARP executive, David Sloane, endorsed the legislation at Tuesday鈥檚 press conference, too, saying physician reimbursement was a top priority for seniors who fear losing their doctors if payments drop too low.
In comments to reporters Monday, however, Sen. Mitch McConnell called the unfunded plan a 鈥済immick鈥� and said it was a transparent attempt to conceal deficit spending in Senate Democrats鈥� health reform proposal.
Leaders in the House have also called on senators to find a way to pay for the bill, since they have put 鈥減ay-go鈥� rules in place that will require them to be able to fund the legislation.
Meanwhile, a Senate aide with knowledge of the legislation said Sen. Kent Conrad, D-N.D., the fiscally conservative chairman of the budget committee, is working with Sen. Charles Grassley, R-Iowa, to carve out an amendment to Stabenow鈥檚 bill that would fully pay for the cuts.