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House Committee Leaders Suggest They're in Sync on SGR Overhaul

By John Reichard, CQ HealthBeat Editor

June 11, 2013 -- Influential lawmakers on two House committees that are pivotal to overhauling the Medicare physician payment system said recently they are working together closely on legislation to replace the sustainable growth rate (SGR) formula, despite some raised eyebrows in recent days about whether they were on the same page.

"We're intending to complete the process through the committee before the August break," Energy and Commerce Committee Chairman Fred Upton told reporters after he spoke to a Washington, D.C., conference. Upton added that the other key committee—Ways and Means, which is chaired by fellow Michigan Republican Dave Camp—may not do its own markup, something that at least one senior Ways and Means member says is still in question.

"Yeah, oh yeah, we're in sync," said Upton. The questions surrounding the two panels' working relationship arose after Upton's panel on May 28 released the latest version of a proposal addressing the SGR. That document that was identified as being from the Energy and Commerce Committee, not as also coming from Ways and Means.

Lobbyists have suggested that the panel may be moving on different tracks, at least temporarily. Ways and Means has direct jurisdiction over a number of potential payment offsets, which likely won't be decided until much later this year when Congress considers debt limit legislation. Energy and Commerce aims to report out a bill soon resolving the policy details concerning what reimbursement approach should replace the SGR. So if there are any differences in opinion over policy and pay fors, Upton and Camp aren't talking about them publicly.

"I'm not sure they'll need to do a markup because of what we're doing," Upton said of the Ways and Means Committee. "We're in absolute sync."

Upton, Camp, and a slew of other lawmakers who play leading roles in tax and health policy spoke at a conference sponsored by the Baker Hostetler law firm and the Yale Club of Washington, D.C.

Ways and Means Health Subcommittee Chairman Kevin Brady, who also spoke at the event, said it would be premature to say his committee won't do its own markup. The Texas Republican said that while the working relationship is "excellent" between the two committees, "we haven't decided on the timetable, on markups, what dates, what months and how we do that."

Brady added that "over the next month it's a laser focus on finding the right replacement."

A bigger hurtle than the ability of lawmakers to reach common ground on the policy concerning how to replace the SGR, is the question of how to offset the 10-year, $139.1 billion cost.

Both Upton and Camp offered no clues about how they do would that, and suggested that none would be forthcoming any time soon.
"We haven't identified a pay for yet, and if I had, I wouldn't be mentioning it to the press," Camp said after his remarks. "I'm obviously working very closely with the [Energy and] Commerce Committee on that and I think they're doing a markup."

"Would you just wait?" Upton good-naturedly admonished a reporter who broached the topic of offsets. "We haven't started yet. We haven't started."

Senate Finance Committee Chairman Max Baucus, D-Mont., has pointed to a tax overhaul as the source of offsets for the SGR fix. But there's plenty of skepticism that any tax overhaul could be completed before the next big physician payment cut is set to take effect Jan. 1. And even if a tax plan is arrived at, it's iffy that it would generate SGR replacement offsets. That means other providers in the Medicare program remain as potentially large targets for cuts later this year to block physician payment cuts.

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