GOP Tries New Tactic in Attack on Obamacare’s Mandate

Republicans plan to tie a delay to measure that would address one of Medicare’s most vexing flaws.

House Speaker John Boehner (R-OH) (L), and House Majority Leader Eric Cantor (R-VA), stand together during in a media availability following a House Republican conference meeting at the U.S. Capitol, on November 2, 2011.
National Journal
Clara Ritger
March 10, 2014, 9:42 a.m.

In the latest pro­pos­al to stall Obama­care’s man­date that all Amer­ic­ans have health in­sur­ance, House Ma­jor­ity Lead­er Eric Can­tor has sched­uled a Fri­day vote to tie it to the per­man­ent “doc fix.”

The vote is on a bi­par­tis­an, bicam­er­al pro­pos­al to re­peal and re­place the broken sus­tain­able growth rate for­mula used to de­term­ine Medi­care pay­ments made to phys­i­cians. That pro­pos­al — also known as the per­man­ent doc fix — has stalled as Con­gress searches for a way to pay for its $138 bil­lion price tag.

GOP Rep. Mi­chael Bur­gess of Texas is the spon­sor of the House ver­sion of the bill, which car­ries a delay of the Af­ford­able Care Act’s in­di­vidu­al man­date as its pay-for.

Delay­ing the in­di­vidu­al man­date by one year would save $9 bil­lion, the Con­gres­sion­al Budget Of­fice es­tim­ates. That’s be­cause few­er people would have health in­sur­ance or en­roll in Medi­caid, sav­ing the gov­ern­ment bil­lions of dol­lars as few­er people seek sub­sidies for in­sur­ance premi­ums or get care at all.

How long of a delay the le­gis­la­tion calls for in or­der to cov­er the cost of the per­man­ent doc fix has yet to be an­nounced. But the pro­pos­al is sure to be ve­toed by the pres­id­ent if not shot down in the Sen­ate.

Ty­ing the SGR talks to the in­di­vidu­al man­date fur­ther slows the ne­go­ti­ations on how to pay for the pro­pos­al, which had the Amer­ic­an Med­ic­al As­so­ci­ation in Wash­ing­ton last week to pres­sure con­gres­sion­al lead­er­ship to get it done.

If Con­gress does not reach agree­ment on the per­man­ent doc fix by March 31, phys­i­cians who provide ser­vices to Medi­care be­ne­fi­ciar­ies face a 20 per­cent pay cut.

Passing the le­gis­la­tion would be a big achieve­ment for Con­gress, which has voted every year since 2003 to stop the cuts to doc­tors’ pay that are man­dated to take ef­fect by SGR for­mula at a cost of roughly $150 bil­lion. The per­man­ent fix car­ries a lower price tag than in pre­vi­ous years, which is why key stake­hold­ers such as the AMA and poli­cy­makers in­volved in the ne­go­ti­ations had been pos­it­ive about the po­ten­tial for a long-term solu­tion.

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