Patient access to care suffers as Congress drags feet on Medicare fix

July 1, 2010

One of the main rallying cries for passage of healthcare reform legislation was to improve access to healthcare for the 47 million (or 32 million, depending on which source you happen to read) Americans who previously didn't have health insurance. Legislation that corrects this obvious shortcoming of our healthcare system is certainly welcomed. However, does this law accomplish that goal?

Key Points

Access to healthcare is extraordinarily important, and legislation that corrects this obvious shortcoming of our healthcare system is certainly welcomed. However, does this law accomplish that goal?

The answer to that question is almost as difficult to answer as it was for this bill to become law. The new law does immediately prohibit health insurers from denying coverage to children on the basis of pre-existing conditions. The law also requires health insurers to provide coverage to dependent children of insured parents up to the age of 26. Additionally, for those patients with long-term, chronic illnesses, insurers will be prohibited from setting lifetime limits on healthcare cost coverage.

While this is all good news as far as I'm concerned, this law has failed to solve at least one chronic problem that has been the source of much frustration by physicians: the needed "fix" to the sustainable growth rate (SGR) for Medicare. The SGR is the flawed formula that the Centers for Medicare and Medicaid (CMS) use to calculate physician payments for providing services to Medicare patients. Instead of finding a solution to this problem, there have only been delays and promises of finding a solution. And the number of delays and postponements is staggering.

Beginning in December 2009, Congress passed a two-month "fix" to avoid the anticipated 21.2 percent cut from taking effect March 1. However, on that date, Congress failed to pass another "fix," and the 21.2 percent Medicare payment cut went into effect. On March 3, Congress passed a short-term fix that was retroactive to March 1, avoiding the cut until the end of March. Yet again, on April 1, Congress failed to pass a solution, and the cut went into effect again (although CMS held claims for 10 business days, giving time for something definitive to hopefully happen).

When nothing happened by April 15, the CMS hold expired and the agency began processing claims under the 21.2 percent reduction rate. But, once again, on April 16, Congress passed another short-term fix (retroactive to April 1), avoiding the cut until May 31.

As of May 21, the congressional Democratic leadership had proposed another temporary fix that would delay scheduled cuts in physician Medicare payments through 2013. Despite lobbying by the American Medical Association to find a permanent solution to this problem, Congress has delayed finding a solution into the future.

If a permanent fix is not developed in rapid fashion, the cumulative payment cut that would result from provisions under the current law would produce an estimated 25 percent across-the-board cut in Medicare payments for all physician services.