By Melissa Attias, CQ Roll Call
March 26, 2015 -- The House backed a package to replace Medicare's oft-criticized physician payment formula last week in an overwhelming bipartisan vote, kicking it over to the Senate, where it faces an uncertain fate as the chamber prepares to leave for a two-week recess.
The legislation (HR 2) passed 392-37, with 212 Republicans and 180 Democrats joining to support the deal negotiated by Speaker John A. Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif. If it clears the Senate, the bill will put an end to a cycle of 17 short-term "doc fix" bills that temporarily averted cuts to Medicare doctors dictated by the sustainable growth rate formula, or SGR.
In addition to replacing the formula, the bill includes a two-year extension of funding for the Children's Health Insurance Program (CHIP) and would require wealthier seniors to pay more for their Medicare outpatient and prescription drug coverage to help offset the cost. The measure is only partially paid for, with the Congressional Budget Office projecting that it would increase the federal deficit by $141 billion over 11 years.
Lawmakers came close to replacing the formula last year when the three committees with jurisdiction over Medicare agreed on a permanent fix, but the effort faltered when lawmakers were unable to agree on offsets. A one-year payment patch (PL 113-93) passed instead will expire in five days, leaving the Senate with a narrow window for action.
"I know that they're working because they know the clock is ticking and no one wants to deny reimbursement to doctors here on the first of the month," said House Ways and Means Health Subcommittee Chairman Kevin Brady, R-Texas. "And so we're just hopeful they'll be able to get it out."
The Centers for Medicare and Medicaid Services plans to continue processing claims from providers. But in an email to health professionals, the agency noted that electronic claims aren't paid until at least 14 calendar days after they're received, providing some cushion before doctors feel the 21 percent scheduled cut. CMS also said it would provide an update by April 11 about whether Congress has acted and next steps.
The broad bipartisan House vote puts additional pressure on the Senate to act before it leaves town for spring break. However, senators could still object to any unanimous consent request to bring up the bill. Some Democrats have expressed concern that the package includes a two-year extension of CHIP funding rather than four years, along with the abortion restrictions applied to money for community health centers.
Sen. Jeff Sessions, R-Ala., also expressed opposition to the deal in a floor speech because the cost is not fully offset and urged colleagues to pass a short-term payment patch instead.
Ben Sasse of Nebraska maintained in an op-ed last week that " the House bill is a missed opportunity to fix Medicare and arguably makes our long-term problems worse" and expressed concern about its potentially rushed consideration.
"Congress should scrap this deal and work on a new solution," he wrote.
While the Obama administration recently released a Statement of Administration Policy supporting the bill, White House Press Secretary Josh Earnest also noted that some senators think it could be "further improved" through amendments and expressed support for providing an opportunity to offer them.
The Senate already has a full plate and is expected to be voting late into the night on amendments to its fiscal 2016 budget proposal (S Con Res 11). An effort to vote on the SGR package could be made after consideration of the budget is complete.
Asked if lawmakers have prepared another short-term patch as a backup measure, Brady said he's sure the Speaker's office is planning for all contingencies "but we're going at full steam ahead."
