President, Congress continue to posture on healthcare reform

April 1, 2010

The Senate on March 2 voted again to delay the 21.2 rate cut caused by the sustainable growth rate formula, delaying it to April 1. The extension should allow lawmakers to pass yet a third extension, this one reportedly slated for seven months, to give Congress more time to come up with a better solution.

Key Points

On March 1, the congressionally mandated 21.2 percent rate cut caused by the sustainable growth rate (SGR) formula took effect, and it did so because one stubborn right-wing senator, Jim Bunning, R-Ky., objected to an emergency House-passed bill that would have delayed the cut for 30 days to give Congress more time to act.

Regardless, the Senate on March 2 voted again to delay the rate cut for a month, pushing it to April 1. The extension should allow lawmakers to pass yet a third extension, this one reportedly slated for seven months (Why seven months? I don't know), to give Congress more time to come up with a better solution.

And while Bunning held everything up that night of Feb. 25, he complained, according to one blogger, that he was missing a basketball game. In that same package was an extension of other important programs, including extension of unemployment benefits for millions of Americans who can't find work, subsidies for COBRA health premiums and highway and transit programs.

Ironically, all of that happened following President Obama's Health Care Summit, which featured seven hours of posturing, pontificating and talking points, but little negotiating about healthcare reform. During those seven hours, I did not hear one word about the need to find a solution to the SGR and the recurring Medicare fee cuts that Congress delays year after year.

AAD push

The American Academy of Dermatology (AAD) has been pressing Congress consistently to find a solution. Early in February, the AAD launched a targeted grassroots campaign to push for comprehensive SGR reform, and AAD members in selected states were asked to urge their senators to fix the SGR.

Certainly, finding a solution would seem to be a core issue for those interested in reforming a healthcare system in which Medicare is such a core component. But the politicians are afraid of adding the estimated $210 billion to $240 billion cost into the already excruciatingly high cost of more than $900 billion over 10 years estimated for the Senate's approach, upon which President Obama seems intent to build.

They can't handle it. But the problem won't go away simply by ignoring it.

"Congress has traditionally put short-term fixes in place to stop the payment cuts from going into effect," the AAD reported in a Health System Reform update, "but they have used a financing gimmick that pushes the cost of offsetting the fix to the next year, meaning that it will cost more every year to avert the cuts."

On Feb. 26, the AAD advised members that the cut would take effect because the Senate was unable to pass the temporary extension by unanimous consent due to Bunning's objection that the $10 billion cost of all of the program extensions in the legislation was not offset with reductions elsewhere.

However, the Centers for Medicare and Medicaid Services in late February notified contractors to hold Medicare physician claims for 10 business days, effective March 1, presumably anticipating another extension by Congress. The agency reportedly sent similar messages to physicians themselves.

Meanwhile, the AAD had its own talking points for the politicians:

Down the road, again

No doubt, by the time you read this, another temporary extension will have been passed. Members of Congress will breathe a sigh of relief, having gotten doctors off their backs for a while, and lawmakers will continue to try to figure out how to reform healthcare.

And then, seven months from now, there will be another crisis, when Congress will probably kick the can down the road one more time.

Bob Gatty, former congressional aide, covers Washington for businesses specializing in healthcare and related issues. Contact him at bob@gattyedits.com
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