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Fight Over 'Doc Fix' Looms in the House Fight Over 'Doc Fix' Looms in the House

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Fight Over 'Doc Fix' Looms in the House

President's budget, Ukraine aid, Fed policies, and more make for a busy week ahead in Congress.

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Congress wrestles with the issue of Medicare physician reimbursements again this week.(Karen Bleier/Getty Images)

Though events in Ukraine are likely to continue dominating attention on Capitol Hill, the House may also be headed toward contentious floor action over how physicians are reimbursed under Medicare.

The current authorization for the sustainable growth rate, better known as the "doc fix," expires March 31, and payments to doctors could be cut by more than 24 percent unless Congress acts.

 

While there is bipartisan support for action to permanently create a new payment system, a plan House Republicans were considering late last week would pay for the move by repealing the individual mandate in the Affordable Care Act—an obvious nonstarter with Democrats, including those who control the Senate.

Unless a permanent solution gets bipartisan support, yet another temporary solution likely will be needed—and the clock is ticking.

House action will contrast sharply with that of the Senate, which is expected to start the week by passing Sen. Claire McCaskill's legislation aimed at reforming how the military handles sexual assaults.

 

The Senate is also expected to pass a nearly $13 billion child care and development block grant bill that has broad bipartisan support. The measure, which authorizes funds aimed at helping low-income families and children, stalled last week when weather delayed the Senate's start.

The bills come at a time when Republicans and Democrats are clashing over Senate procedure and how the chamber is run, and are likely to give both sides a break. Here's what else Congress is up to this week:

  • The House is expected to pass by a wide margin a resolution condemning the violation of Ukrainian sovereignty on Tuesday. A bipartisan group of senators has proposed a similar resolution but the likelihood of a vote is uncertain.
  • On Tuesday, the Senate Foreign Relations Committee will mark up a package of aid to Ukraine that is described as more "comprehensive" than a bill the House passed last week.
  • Treasury Secretary Jacob Lew will testify on Wednesday before the House Budget Committee on the revenue and economic policy proposals in the president's fiscal 2015 budget.
  • The Senate Health, Education, Labor, and Pensions Committee will hold a hearing Wednesday on raising the federal minimum wage, which the administration and Democrats have been pushing as an election-year issue.
  • On Wednesday, Housing and Urban Development Secretary Shaun Donovan will testify before a Senate Banking subcommittee on recovery efforts from 2012's Superstorm Sandy, which badly damaged parts of the Northeast.
  • The House will take up a number of Republican bills to address what they claim has been overreach by the Obama administration. One would require federal officials to report when the administration fails to enforce a law and another would establish procedures for the House and Senate to authorize a lawsuit to sue the administration for failure to execute laws.

The House GOP's plan to address the doc fix permanently was announced late last week on the chamber floor by Rep. Mike Conaway of Texas. The notion that they plan to incorporate another messaging effort on Obamacare was not well-received.

Minority Whip Steny Hoyer immediately began to press Conaway on how it would be paid for, and whether Republicans, in fact, would try to use repeal of the individual mandate under Obamacare. Under such thinking, presumably, such a repeal would lead to fewer people enrolling in the health care program, and thus cost the government less in subsidies.

 

Where to find budget offsets to pay for a permanent fix has been a challenge. The Congressional Budget Office estimated earlier this year that it would cost about $139 billion over 10 years, and that amount was actually lower than previous CBO estimates.

As a result, Congress over the past 10 years has spent nearly $150 billion on short-term solutions to prevent the cuts, either by increasing physician payment rates or freezing rates to prevent decreases. But that also produces uncertainty for physicians about whether or when Medicare reimbursements will be cut.

Conaway said the final decision on an offset would be finalized as an amendment in the House Rules Committee before the bill is taken to the floor for a vote.

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New Senate Finance Committee Chairman Ron Wyden of Oregon said he too wants to find a permanent fix, but stopped short of laying out a path forward, saying last week that the issue is coming up at "very challenging time."

ECONOMY

Focus on the Fed

On Tuesday, a Senate Banking subcommittee will discuss capital regulations for insurance companies, which say the 2010 Dodd-Frank financial reform law unfairly subjects them to the same rules as financial firms. Republican Sen. Susan Collins, the author of the law's relevant provision, is among those scheduled to testify.

Also on Tuesday, the Labor Department will release its latest Job Openings and Labor Turnover Survey (JOLTS), which is a measure of how much "churn" (hires and quits) there is in the labor market. It's one of the data points the Federal Reserve considers when deciding how much stimulus to provide the economy, and provides a window into the health of the job market.

On Wednesday, Housing and Urban Development Secretary Shaun Donovan will testify before a Senate Banking subcommittee on recovery efforts from 2012's Superstorm Sandy, which badly damaged parts of the Northeast. Separately, a House Financial Services subcommittee will hold a hearing to examine the Federal Reserve's role in credit allocation, part of the committee's pledge to spend the year examining the Fed.

Also on Wednesday, the Senate Health, Education, Labor, and Pensions Committee will hold a hearing on raising the federal minimum wage, which the Obama administration and Democrats have been pushing as an election-year issue.

Finally, Treasury Secretary Jacob Lew will testify Wednesday before the House Budget Committee on the revenue and economic policy proposals in the president's fiscal 2015 budget. The White House Office of Management and Budget will release supplemental materials for its budget plan on Monday morning; these include analytical perspectives and historical tables. The bulk of the president's budget was released last week.

A hearing on Federal Reserve Board nominees, originally scheduled to take place last week, will now take place Thursday. Stanley Fischer, former head of the Bank of Israel and nominee to be the Fed's vice chair; Lael Brainard, former Treasury undersecretary for international affairs; and Jerome Powell, who is currently a member of the Fed's Board of Governors, will testify before the Senate Banking Committee, as will a nominee to be an assistant secretary at the Housing and Urban Development Department and a separate nominee to be a member of the National Credit Union Administration Board.

ENERGY AND ENVIRONMENT

Climate Night

House conservatives are set to continue their attack on Environmental Protection Agency efforts to regulate power-plant carbon emissions with a hearing convened by a House Science subcommittee on Wednesday. The hearing will examine the feasibility of carbon capture and storage, a technology that EPA has mandated for new power plants in a draft regulation unveiled in September.

The administration says the technology is ready for prime time; conservatives say it has not yet been demonstrated on a commercial scale. The agency's acting assistant administrator for the Office of Air and Radiation, Janet McCabe, will testify during the hearing.

Sen. Sheldon Whitehouse and other Senate Democrats trying to play political offense on climate change will make floor speeches all night Monday into Tuesday morning. Whitehouse and Sen. Barbara Boxer, chair of the Environment and Public Works Committee, several weeks ago formed the Climate Action Task Force to raise the topic's visibility.

HEALTH CARE

'Doc Fix' Redux

The House will vote next week on "doc fix" legislation that includes repealing the Affordable Care Act's individual mandate as the pay-for. Lawmakers on both sides support permanent repeal of the sustainable growth rate payment formula for Medicare physicians, but have not worked out a way to cover the cost.

The bill put forward by House Republicans puts Democrats in an uncomfortable position of voting against a fix, as repealing the individual mandate would have harmful effects on the ACA.

The bill is likely to pass the House, but unlikely to make it through the Democratic-controlled Senate. Lawmakers have until March 31 to come up with a doc-fix solution, or physicians will face major pay cuts.

On Wednesday, Health and Human Services Secretary Kathleen Sebelius will testify in a House Ways and Means Committee hearing on the president's 2015 budget proposal for HHS.

In the proposal, the Centers for Medicare and Medicaid Services is asking for $629 million for implementation of the federal marketplace in 2015. The agency plans to collect $1.2 billion in user fees from issuers to offset the cost, bringing total spending to $1.8 billion next year. Funding for the state exchanges is at the discretion of the administration and states' needs. The administration estimates it will spend $6.4 billion to support state insurance exchanges by the end of 2015.

Wednesday's hearing will be held at 10 a.m. in the Longworth House Office Building.

The House Labor, Health and Human Services, Education Appropriations Subcommittee will hold a hearing on "the Future of Biomedical Research" on Thursday morning.

The director of the National Institutes of Health, Francis Collins, will testify, along with Harold Varmus, director of the National Cancer Institute; Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Story Landis, director of the National Institute of Neurological Disorders and Stroke; and Gary Gibbons, director of the National Heart, Lung, and Blood Institute.

That hearing is scheduled for 10 a.m. in the Rayburn House Office Building.

Also on Thursday, the Senate HELP Committee will hold a hearing entitled "Protecting the Public Health: Examining FDA's Initiatives and Priorities." The hearing will be at 10 a.m. in the Dirksen Senate Office Building. Witnesses have not yet been announced.

NATIONAL SECURITY

Ukraine Aid

The president's budget, aid for Ukraine, and the National Security Agency are in the spotlight this week.

The Senate starts out the week with a vote on legislation to combat military sexual assault. A proposal from Sen. Claire McCaskill would build on recent reforms enacted in last year's defense authorization act. The bill is expected to sail through the chamber after unanimous approval of a procedural motion last week.

On Tuesday, Senate Foreign Relations Committee leaders Robert Menendez, D-N.J., and Bob Corker, R-Tenn., plan to mark up their own package of aid to Ukraine that they have described as more "comprehensive" than the bill the House passed last week.

Also on Tuesday, the Senate Armed Services Committee holds a hearing to consider the nomination of Vice Adm. Michael Rogers to be admiral and director of the NSA, chief of Central Security Services, and the head of U.S. Cyber Command.

Secretary of State John Kerry testifies in back-to-back hearings before Senate Foreign Relations on Wednesday and the House Foreign Affairs Committee on Thursday regarding national security and foreign policy priorities in the president's budget request.

The situation in Afghanistan is the subject of back-to-back hearings Wednesday and Thursday before the Senate and House Armed Services committees.

On Thursday, Senate Foreign Relations holds a hearing on the contentious Keystone XL pipeline and the national-interest determination.

TECHNOLOGY

Internet Taxes

The House Judiciary Committee will hold a hearing at 10 a.m. Wednesday to consider whether to empower states to tax online purchases.

The Senate passed an online sales tax bill last year, and House Judiciary Committee Chairman Bob Goodlatte has said he would consider legislation as long as it meets certain conditions.

Clare Foran, Ben Geman, Catherine Hollander, Stacy Kaper, Sophie Novack, and Brendan Sasso contributed to this article.

This article appears in the March 10, 2014 edition of NJ Daily.

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