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House GOP Doc Fix Provision Hits Up Health Care Law for Offsets

By John Reichard and Emily Ethridge, CQ Staff

December 8, 2011 -- Included in the legislative package House GOP lawmakers discussed early Thursday is a two-year Medicare physician payment patch that would be offset in part with cuts to spending on the health care overhaul and to Medicare premium increases, sources say.

Rep. Phil Gingrey, R-Ga., said the patch would block a 27 percent cut in payments to doctors scheduled for Jan. 1 and replace it with a 1 percent increase in reimbursements in 2012 and 2013.

“That was a pleasant surprise,” Gingrey said. “We had no reason to expect that but we’re pleased with that. I’m going to whip the doctors caucus and ask each one of them to vote for this next Tuesday. I told the whip team that I certainly will vote yes.”

However, Senate Majority Leader Harry Reid, D-Nev. made clear later Thursday that the House GOP legislative package, which would continue the expiring Social Security payroll tax cut for employees and address unemployment insurance, wasn’t going anywhere in the Senate.

Even with the larger package in doubt, a number of the various pay-for provisions in play may yet end up in a final deal.

Gingrey said that cuts to the health care law (PL 111-148, PL 111-152) would include reduced spending for the overhaul’s preventive care fund. And the package would raise the cost of Medicare premiums for individuals earning more than $1 million.

Republicans have not released a formal list of all the payment offsets they are considering.

According to a congressional source, the health care law cuts would reduce subsidies to buy health insurance and trim funding for the Centers for Medicare and Medicaid Innovation, in addition to draining the prevention fund.

Provisions of the pay-for package appeared to be in flux throughout the day Thursday. Estimates on the size of the health law cuts ranged from $20 billion to $42.9 billion over 10 years.

GOP lawmakers are considering two other possible Medicare cuts to providers but have not decided one way or the other as to whether to include them. One would shrink payments to providers to reduce “bad debt”—to offset their losses from patients not paying out-of-pocket charges. Medicare spending also might be reduced by adjusting outpatient “E/M” billing codes for “evaluating and managing” patients. GOP lawmakers considered but rejected cuts to Medicare funds for medical imaging and home care, the source said.

On Wednesday, the American Hospital Association (AHA) shifted into high gear to try to head off the E/M changes, sending an alert to member facilities and urging them to contact lawmakers to express their opposition. The E/M change would trim $10 billion over 10 years from outpatient hospital department payments, the AHA alert said.

In his statement Thursday on the House GOP plan, Reid said that “House Republican leaders had to entice their members into supporting their proposal by weighing it down with a laundry list of policies whose sole purpose are scoring points against President Obama. House Republicans’ bill is a partisan joke that has no chance of passing the Senate,” Reid said. “Instead of playing political games, Congress should work to find common ground,” he added.

Dena Bunis contributed to this story

John Reichard can be reached at
[email protected].  

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