In a surprise move, physicians will get a Senate vote as early as next week on a Medicare payment fix that helps them avoid massive cuts as House Democratic leaders work to set up that chamber's own separate vote on a payment solution.
The Senate move will appease physicians who have leaned on senators to use the overhaul to permanently fix a payment structure that leaves physicians facing annual cuts in Medicare reimbursement, including a 21 percent reduction looming next year. Physicians argue other payment reforms that focus reimbursement on quality rather than quantity are not as effective if the medical community continues to face cuts.
Physician lobbyists met Wednesday evening with White House healthcare czar Nancy-Ann DeParle, Senate Majority Leader Reid, Senate Finance Chairman Max Baucus and Sen. Christopher Dodd, D-Conn. Senate Democratic leaders made a procedural move Tuesday night that allows the chamber to bypass the usual committee process and take the $245 billion fix, proposed by Sen. Debbie Stabenow, D-Mich., straight to the floor.
Reid, Baucus and Dodd also met Wednesday with White House officials, including DeParle, White House Chief of Staff Emanuel and HHS Secretary Sebelius, to discuss merging the Finance and Senate Health, Education, Labor and Pensions committees' overhaul bills. The senators are expected to meet again today with administration officials, a spokesman for Reid said.
Leadership has indicated the merger will be swift. Baucus indicated Wednesday that might not be the case for the rest of the road ahead. When asked whether the panel can take up climate legislation before Thanksgiving, Baucus said, "I just don't know. Frankly, I think healthcare reform is going to take a little longer than people think."
The Senate could vote on the physician fix as early as next week. The fix faces three tough procedural hurdles that each will require 60 votes: a cloture vote, a budget point of order because the measure is not offset and a motion to proceed to the bill, a lobbyist source said.
Sources expect Reid to file cloture today, setting up a Monday vote to limit debate.
Stabenow's bill will repeal the formula, known as the sustainable growth rate, that determines Medicare physician payment. "SGR is one part of the physician reimbursement formula, and the Finance mark contains a new system based on quality that will move physician reimbursement away from rewarding for quantity to rewarding for quality. We have to eliminate the SGR in order to move toward the new system," Nkenge Harmon, Stabenow's communications director, said.
The Finance proposal gives physicians a 0.5 percent payment increase next year and leaves open the possibility of future increases.
Across the Capitol, Rep. Chris Van Hollen, D-Md., the assistant to the speaker, said the House will split the physician payment fix from the House overhaul bill as its own separate legislation to be voted on "in the same time period" as the overhaul.
House Majority Leader Hoyer said earlier Wednesday the decision had not been made to separate the physician fix. "But my view is that whatever we do with the doc fix we would do with or without healthcare reform, and healthcare reform really needs to be considered on its own merit and the SGR fix on its own merit," Hoyer said.
A House Democratic aide said the discussions are ongoing.
The House already voted as part of its budget resolution to exempt the $245 billion fix from pay-go requirements, but extracting it from the overhaul bill will help bring down the overall cost of the measure. The House has been searching for a way to get its overhaul bill closer to $900 billion, as President Obama has indicated he prefers, rather than the approximately $1 trillion it is at now.
The House legislation would eliminate future cuts and create a new payment formula to encourage efficiency like Finance's proposal.
A lobbyist source said the physician fix could end up back in the overhaul proposal through a House maneuver known as a "self-executing rule," that, according to the Congressional Research Service, "may stipulate that a discrete policy proposal is deemed to have passed the House and been incorporated in the bill to be taken up" once the House passes the rule governing floor time for the larger piece of legislation under consideration. This would allow the House to claim its bill is deficit-neutral even when the fix is attached and not offset.
This article appears in the October 17, 2009 edition of NJ Daily.