Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


'Doc Fix' Deal Opens Health Battles Ahead

By Melissa Attias, CQ Roll Call

Congress may have finally put an end to the cycle of 17 short-tem "doc fixes" with the passage of legislation that would change the way Medicare pays doctors. But the bill's handling, or sidestepping, of other programs sets the stage for future fights.

The Senate cleared the package to replace Medicare's sustainable growth rate formula, or SGR, last week in a 92–8 vote and President Barack Obama said in a statement that he "will be proud to sign it into law." While most physician lobbyists are basking in their successful effort to do away with the SGR, it won't be long before those groups and other players turn to issues that are still unresolved.

At the top of the list is the effort to permanently repeal caps on Medicare spending for therapy services, which the Senate came close to accomplishing in one of the tightest votes of the night. Maryland Democrat Benjamin L. Cardin's amendment fell two votes short of the 60 required to overcome a budget point of order, a defeat that may have stemmed more from concerns about sending the bill back to the House rather than problems with changing the policy.

"I think there was a lot of discomfort with the idea of the bill actually getting amended," said Mandy Frohlich, vice president of government affairs for the American Physical Therapy Association. "My sense was the votes were there."

Senate Finance Chairman Orrin G. Hatch alluded to the conundrum when he raised the budget point of order against the amendment. The Utah Republican said House leadership wouldn't pass another bill. He acknowledged that the caps "may not be the best policy" but said they rein in unnecessary Medicare spending.

"Congress should use the next two years to find a solution to this problem and work for pay—to pay for that solution, and I intend to do that," Hatch said. "But to have that on this bill would just be a catastrophe at the end of what has been a really, really, very, very tough-fought bill all the way through."

The physician payment package extends a process that allows patients to receive medically necessary services beyond the annual limits through the end of 2017, although Frohlich noted that she would prefer action on repeal sooner.

Supporters have said permanently scrapping the caps would cost between $8.8 billion and $13 billion. The influential seniors lobby AARP made the Cardin amendment a key vote.

Another issue, also the subject of an unsuccessful amendment last week, will be the effort to extend funding for the Children's Health Insurance Program (CHIP) beyond fiscal 2017. Democrats wanted to see four more years of funding rather than the two included in the bill. Republicans want to overhaul the program.

Bruce Lesley, president of the First Focus Campaign for Children, hinted at the fight ahead in a statement thanking Colorado Democrat Michael Bennet for offering the amendment. The program is designed for children whose families make too much to qualify for Medicaid but not enough to afford private coverage.

"As we redouble our efforts to extend CHIP again in 2017, it's good to know that we can count on leaders like Senator Bennet," Lesley said in a statement.

Two issues that were broached in an amendment from Washington Democrat Patty Murray, meanwhile, represent future spending battles on the primary care front.

The first is a now-expired provision in the health care law that provided two years of elevated funding for Medicaid primary care doctors in an effort to match higher Medicare payment rates. Murray's amendment proposed renewing and expanding the provision and advocates are expected to continue to press the case. They face an uphill battle in a Republican Congress.

The second is money for community health centers, the National Health Service Corps and teaching health centers, which are funded through fiscal 2017 in the physician package. The programs were slated to lose mandatory money at the end of September in what had been dubbed the primary care cliff. Murray unsuccessfully tried to extend funding two more years through fiscal 2019.

Of course, Congress will also grapple with other Medicare and health policies that will be losing their legislative vehicle with the elimination of the SGR. Two of those include extra money for hospitals that have a low-volume of discharges and small, rural hospitals with a high percentage of Medicare patients. Both expire Oct. 1, 2017.

Lobbyists will also be closely following the implementation of the new physician payment system, particularly provisions designed to measure quality. James L. Madara, CEO of the American Medical Association, said on a call with reporters that the organization will be working with the federal government to ensure it pans out correctly.

But Madara also sees the end of the payment formula as a liberating moment, maintaining that it will allow "a brighter light to be shined" on his organization's work to advance payment delivery systems. "At times I fear it was overshadowed by the attentiveness to the SGR flawed payment system itself," he said.

Publication Details