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Ryan Rules Out Permanent 'Doc Fix' Before Deadline

By Melissa Attias, CQ Roll Call

March 3, 2015 -- House Ways and Means Chairman Paul D. Ryan recently told a hospital group that there isn't consensus on how to pay for a permanent repeal of Medicare's physician payment formula and that Congress "will have to buy time" and pass another short-term bill to avert cuts of about 21 percent due to take effect April 1.

Physician groups and other medical professionals have been pushing hard for Congress to permanently replace the formula—known as the sustainable growth rate or SGR—before a temporary payment patch expires at the end of March. In a recent letter, the American Academy of Family Physicians urged congressional leaders to "to move beyond these short-term, stop-gap measures that have become the accepted course of action on this issue."

Ryan, R-Wis., told a Federation of American Hospitals conference in Washington, D.C., that he supports a bipartisan, bicameral replacement policy reached last year, but that the recently-raised $174.5 billion price tag remains a problem.

While Republicans are "trying to engage" with Democrats, Ryan said the parties have opposing views on what a Medicare overhaul should look like. He characterized Democrats' general position as continuing implementation of the health care law, including a Medicare cost-cutting board he criticized earlier in his remarks, and taking money away from providers.

"There are other issues, like Medicare reform-based issues, we'd like to enter into this to try and help pay for this," he said.

Ryan also said that other fiscal issues crowding the agenda, including the budget sequester, could lead to a broader fiscal policy discussion or another budget agreement that could serve as an opportunity to move forward on the SGR.

"Sometimes you find if you have a problem that's small and intractable, if you make it a little bit bigger it's actually easier to solve, and that's kind of the way we're looking at the full-time doc fix," he said. "So we'll have to do something in the short term we believe because we don't yet have consensus on what a 10-year permanent repeal looks like."

Beyond Medicare payments, Ryan said that House Republicans will outline a plan should the Supreme Court strike down the health law's system for distributing insurance subsidies in a Wall Street Journal editorial last week and put it in legislative form by June for the expected ruling. A trio of leading Senate Republicans later offered the bare contours of their planned response in an op-ed.

"Our goal is to have legislation ready to go come June 20 or whenever this ruling will come out so that we have a bridge out of this problem, out of Obamacare, to a system where people won't get caught in the crossfire, won't get caught with collateral damage," Ryan said.

In addition, Ryan said the House will move legislation this year to repeal the health law's tax on medical devices and that he thinks the Senate will take it up. But he said he's unsure whether President Barack Obama would veto it.

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