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.

A physician with stethoscope poses on October 19, 2009 in Manassas, Virginia. A new poll released October 20, 2009 found most Americans support one of the most controversial healthcare reform options being debated by lawmakers.The Washington Post-ABC News poll found 57 percent of Americans either strongly or somewhat support 'having the government create a new health insurance plan to compete with private health insurance plans.' Some 40 percent said they were strongly or somewhat opposed to the so-called public option, which President Barack Obama has said he favors but does not consider a non-negotiable component of any health care reform. AFP PHOTO/Karen BLEIER (Photo credit should read KAREN BLEIER/AFP/Getty Images)
National Journal
March 9, 2014, 9:25 a.m.

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.

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.”


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.


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.


‘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.


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.


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