United States Congress, bipartisan medicare doctors bill in senate. Just 24 hours before physicians would face a 21% cut in their Medicare pay, the U.S. Senate overwhelmingly passed legislation that would permanently remove the sustainable growth rate formula that dictates pay. The fix will cost $220 billion over the next 10 years; Congress has identified ..
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United States Congress, bipartisan medicare doctors bill in senate. Just 24 hours before physicians would face a 21% cut in their Medicare pay, the U.S. Senate overwhelmingly passed legislation that would permanently remove the sustainable growth rate formula that dictates pay.
The fix will cost $220 billion over the next 10 years; Congress has identified about $73 billion in cuts to other programs to help cover the cost.
The Senate’s reform package mirrored a House bill approved two weeks ago. President Obama has said he will sign it. “It’s a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs,” he said in a statement.
The Senate vote on the bill began shortly after 7:00 pm on Tuesday, just before a key deadline that would have triggered the 21% cuts to Medicare doctors. The final votes were cast just before 10:00 pm. A vote on the legislation got bogged down by amendments from both parties, including one from Sen. Ben Cardin, D-Md., to repeal Medicare’s limits on physical therapy coverage. But the amendment ultimately failed to reach the 60-vote threshold, getting 58 votes.
Once signed by the President, the bill would repeal annual, automatic cuts to doctors’ payments under the Sustainable Growth Rate (SGR). “This has been a long ordeal that a lot of us have worked on for a long time,” Senate Finance Committee chairman Orrin Hatch, R-Utah, told the media ahead of the vote, calling it a “major, major accomplishment.” Congress has interceded 17 times to halt the physician pay cuts.
House Speaker John Boehner, R-Ohio, who quietly started negotiations on the bill earlier this year, has similarly praised the bill as “the first real entitlement reform in two decades.”
Prior to the vote, conservatives in the Senate remained concerned about how the bill was going to be paid for. To win support from them on the overall bill, leadership allowed a vote on an amendment from Sen. Mike Lee, R-Utah, that would have forced lawmakers to fully pay for the bill. The measure was defeated, 58-42.
The bill will cost $214 billion over 10 years, with $73 billion of that cost offset with spending cuts or new revenue, according to the Congressional Budget Office (CBO). The bill includes reforms to transition Medicare’s payment system from incentivizing quantity to quality in care and is likely to produce small savings for the government over time, according to the CBO.
However, Sessions and conservative groups like the Heritage Foundation pointed out that the Medicare agency’s actuary warned last week that Congress could need to pass more legislation down the road to ensure that Medicare doctors do not lose out in the second decade of the law.
To help pay for the measure, the bill makes beneficiaries paying more than $133,000 a year to pay a higher share of premium costs. Democrats had also objected that the bill includes just two years of funding for the Children’s Health Insurance Program. An amendment to increase it to four years of funding failed on Tuesday.
The Centers for Medicare and Medicare Services (CMS) told providers last week that it is already preparing to make the 21% cuts if Congress does not act. But officials also sought to calm tensions by pointing out they can hold checks for 14 calendar days under current law to temporarily protect doctors from the cutbacks.
Highlights of House-passed legislation the Senate debated Tuesday changing how Medicare reimburses doctors. The bill would spend $214 billion over 10 years:
COSTS:
-Medicare payments to doctors: $175 billion. Blocks 21 percent reduction that technically took effect April 1. Provides 0.5 percent annual increases through 2019, creates new payment system with incentives for doctors to bill for overall care, not per treatment.
-Children’s Health Insurance Program: $5.6 billion so program serving low-income children can operate in 2016 and 2017.
-Extension of expiring Medicare programs: $6 billion. Two-year renewals for extra payments for rural hospitals and ambulances, private Medicare Advantage plans for people with disabilities, exemptions to annual patient limits on physical and occupational therapy.
-Miscellaneous health programs: $27 billion. Makes permanent programs subsidizing Medicare medical premiums for low-income people, keeping people on Medicaid as their incomes grow. Includes extra $3.6 billion annually for two years for community health centers. Extends financing for abstinence education, training low-income people for health care jobs, home-care visits for families with young children.
HOW IT’S FINANCED
-$141 billion added to federal deficits.
-$35 billion from higher-income Medicare recipients. In 2018, Medicare’s medical and prescription drug monthly premiums would rise for people earning from $133,500 to $214,000, roughly 2 percent of beneficiaries, according to nonpartisan Kaiser Family Foundation. In 2020, income thresholds that trigger higher premiums would rise less than planned, so more people would pay them. Also starting in 2020, people could not buy new Medigap policies covering Medicare’s medical deductible, currently $147 yearly.
-$37 billion from reducing Medicare payments to hospitals, nursing homes, home health services. Treasury Department can impose levy of up to 100 percent on Medicare providers owing delinquent taxes.
OTHER PROVISIONS
-Helps Medicare cost plans, offered by private companies in some states, become private Medicare Advantage plans, which are generally more profitable. Dominant companies include Blue Cross and Blue Shield and Medica Health Plans, according to Kaiser, and most of the 471,000 people covered last year lived in Minnesota.
-Hospitals won 6-month extension of ban on auditors examining whether short in-patient stays are medically necessary.
WASHINGTON — Conservatives hated that it’s expected to swell federal deficits over the coming decade. Liberals complained that it shortchanged health programs for children and women.
But after years of complaints and failed efforts, huge majorities of both parties in Congress finally banded together and there was no stopping the “doc fix.”
The Senate gave final approval late Tuesday to the $214 billion bipartisan measure, which permanently recasts how Medicare reimburses doctors for treating over 50 million elderly people. It also provides extra money for health care programs for children and low-income people, which Democrats coveted, and imposed higher costs on some higher-income Medicare beneficiaries, which Republicans touted as a victory.
Most immediately, the bill prevented a 21 percent cut in those physicians’ Medicare fees that would have hit home Wednesday when a federal agency planned to start making payments reflecting that reduction. That would have ensured a flood of complaints from doctors and senior citizens that lawmakers dearly wanted to avoid.
“This bipartisan bill will protect health coverage for millions of Americans, and I will be proud to sign it into law,” President Barack Obama said after the Senate vote.
Said Senate Majority Leader Mitch McConnell, R-Ky., “Instead of kicking this important Medicare payment issue down the road again, a strong bipartisan majority in Congress voted to finally solve the problem and ensure that seniors on Medicare don’t lose access to their doctors.”
The Senate roll call was 92-8, with all eight “no” votes coming from Republicans. Among presidential hopefuls, Sens. Ted Cruz, R-Texas, and Marco Rubio, R-Fla., voted against the bill, while Rand Paul, R-Ky., supported it.
By an overwhelming 392-37, the House approved the legislation last month after the compromise was crafted by House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif. Their joint effort marked an uncharacteristic accord to address a problem that both parties wanted resolved.
For congressional leaders including McConnell, passage provided an opportunity to demonstrate that they and their parties can govern.
“It’s another reminder of a new Republican Congress that’s back to work,” he said.
The bill’s chief feature was its annulling of a 1997 law aimed at slowing the growth of Medicare that has repeatedly threatened deep cuts in reimbursements to physicians and led to threats by doctors to stop treating the program’s beneficiaries.
Congress has blocked 17 reductions since 2003, an exercise that invites intense lobbying and difficult choices about finding budget savings that both parties detested. Lawmakers had tried before to void the old formula but fallen short, usually over disagreements over how to pay for a new reimbursement system.
The approved bill would create a new payment system with financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits.
But before the measure cleared the Senate, lawmakers had to band together and reject six amendments — three from each party. Approval of any changes could have doomed the bill by unraveling the careful compromise between Boehner and Pelosi.
By 58-42, the chamber rejected an effort by conservatives to force Congress to find enough savings to pay for the entire measure without increasing federal red ink. As written, two-thirds of the bill’s $214 billion, 10-year price tag was financed by making huge federal deficits larger still. McConnell and No. 2 GOP leader John Cornyn were among 12 Republicans to oppose the amendment by Sen. Mike Lee, R-Utah.
Senators rejected an amendment by Sen. Patty Murray, D-Wash., beefing up programs for women’s health. Also defeated was a proposal by Sen. Michael Bennet, D-Colo., providing four years of extra money for the Children’s Health Insurance Program instead of the measure’s two years.
Though $141 billion of the bill’s costs is borne by additional federal red ink, $35 billion comes from higher expenses for Medicare beneficiaries.
Most of that would come from raising the medical and prescription drug premiums paid by some upper-income recipients starting in 2018. Though the affected beneficiaries already pay higher premiums than lower-earning people, Congress seldom increases costs on seniors, fearing retribution come the next Election Day from older voters.
The bill would raise another $37 billion by cutting Medicare reimbursements to hospitals and other providers.
The 21 percent cut in doctors’ fees technically took effect April 1. Citing federal law, the Centers for Medicare and Medicaid Services stopped processing those claims two weeks ago — in effect giving lawmakers time to complete the legislation. The agency processes around 4 million Medicare payments for doctors daily.
Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Ceza Hoffman
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