Baucus Ready to Push for ‘Doc Fix’

Baucus: No deal on tax cuts until after Thanksgiving.
National Journal
Billy House
Nov. 21, 2013, 12:19 p.m.

Sen­ate Fin­ance Com­mit­tee Chair­man Max Baucus says his pan­el will con­sider so-called “doc fix” legis­la­tion  to re­peal the rate for­mula used for phys­i­cian re­im­burse­ment un­der Medi­care when law­makers re­turn to Wash­ing­ton in Decem­ber.

The Montana Demo­crat sent out a no­tice Thursday to fel­low com­mit­tee mem­bers an­noun­cing they will meet in “open ex­ec­ut­ive ses­sion” on Dec. 12 “to con­sider an ori­gin­al bill to re­peal what is of­fi­cially known as the Medi­care Sus­tain­able Growth Rate (SGR) for­mula.”

The le­gis­la­tion that Baucus will of­fer will be dis­trib­uted 48 hours be­fore the start of that meet­ing.

However, there re­main sig­ni­fic­ant stum­bling blocks to any ma­jor over­haul of the doc fix — in­clud­ing how to pay for it — even as bi­par­tis­an sup­port for re­peal has gained mo­mentum.

Un­less Con­gress acts by Jan. 1 in some man­ner, Medi­care phys­i­cian pay­ments will be cut by about 24.4 per­cent.

At the root of the prob­lem is that the SGR for­mula en­acted in 1997 as a way of con­trolling Medi­care spend­ing es­tab­lished a fee sched­ule with cal­cu­lated an­nu­al up­dates for more than 7,000 phys­i­cian ser­vices un­der Medi­care. But as the eco­nomy began to slow and health care costs began to out­pace gross do­mest­ic product growth, the for­mula pro­duced de­creases in phys­i­cian fees each year, start­ing in 2002.

Over the past 10 years, Con­gress has spent nearly $150 bil­lion on short-term SGR patches or “over­rides” to pre­vent such cuts, either by in­creas­ing phys­i­cian pay­ment rates or freez­ing rates to pre­vent de­creases. But each year that has pro­duced un­cer­tainty for phys­i­cians about wheth­er or when their Medi­care re­im­burse­ments will be cut.

On Oct. 31, Baucus and Fin­ance Com­mit­tee rank­ing mem­ber Or­rin Hatch, R-Utah — joined by House Ways and Means Chair­man Dave Camp, R-Mich., and that pan­el’s top Demo­crat, Rep. Sander Lev­in, D-Mich. — re­leased a “dis­cus­sion draft out­line” on per­man­ently fix­ing the SGR. That draft called for an SGR re­peal that would in­clude a 10-year freeze and a per­form­ance-based in­cent­ive pro­gram start­ing in 2017.

While Baucus is now mov­ing for­ward with his ver­sion of a bill, Camp’s com­mit­tee in the House con­tin­ues to take “the feed­back from the draft re­leased last month and [is] eval­u­at­ing com­ments,” said an aide.

It re­mains un­cer­tain how any per­man­ent SGR fix, or an­oth­er tem­por­ary one, might ul­ti­mately be ap­proved this year, either as a stand-alone item or part of a lar­ger budget bill pos­sibly be­ing worked out by a bi­par­tis­an budget con­fer­ence com­mit­tee.

It also is not clear where budget off­sets might be found to pay for a per­man­ent re­peal. The Con­gres­sion­al Budget Of­fice es­tim­ated earli­er this year that it would cost about $139 bil­lion over 10 years, which was lower than pre­vi­ous CBO es­tim­ates.

What We're Following See More »
HE ‘WILL NEVER BE PRESIDENT’
Warren Goes After Trump Yet Again
7 hours ago
THE LATEST

When it comes to name-calling among America's upper echelon of politicians, there may be perhaps no greater spat than the one currently going on between Sen. Elizabeth Warren and Donald Trump. While receiving an award Tuesday night, she continued a months-long feud with the presumptive GOP presidential nominee. Calling him a "small, insecure moneygrubber" who probably doesn't know three things about Dodd-Frank, she said he "will NEVER be president of the United States," according to her prepared remarks."We don't know what Trump pays in taxes because he is the first presidential nominee in 40 years to refuse to disclose his tax returns. Maybe he’s just a lousy businessman who doesn’t want you to find out that he’s worth a lot less money than he claims." It follows a long-line of Warren attacks over Twitter, Facebook and in interviews that Trump is a sexist, racist, narcissistic loser. In reply, Trump has called Warren either "goofy" or "the Indian"—referring to her controversial assertion of her Native American heritage. 

FIRST CHANGE IN FOUR DECADES
Congress Passes Chemical Regulations Overhaul
9 hours ago
THE DETAILS

The House on Tuesday voted 403-12 "to pass an overhaul to the nation’s chemical safety standards for the first time in four decades. The Frank R. Lautenberg Chemical Safety for the 21st Century Act aims to answer years of complaints that the Environmental Protection Agency lacks the necessary authority to oversee and control the thousands of chemicals being produced and sold in the United States. It also significantly clamps down on states’ authorities, in an effort to stop a nationwide patchwork of chemical laws that industry says is difficult to deal with."

Source:
NO MORE INDEPENDENT VOTERS?
GOP Could Double Number of Early Primaries
10 hours ago
THE DETAILS

"Leaders of the Republican Party have begun internal deliberations over making fundamental changes to the way its presidential nominees are chosen, a recognition that the chaotic process that played out this year is seriously flawed and helped exacerbate tensions within the party." Among the possible changes: forbidding independent voters to cast ballots in Republican primaries, and "doubling the number of early states to eight."

Source:
LEVERAGE
Kasich Tells His Delegates to Remain Pledged to Him
12 hours ago
THE LATEST

Citing the unpredictable nature of this primary season and the possible leverage they could bring at the convention, John Kasich is hanging onto his 161 delegates. "Kasich sent personal letters Monday to Republican officials in the 16 states and the District of Columbia where he won delegates, requesting that they stay bound to him in accordance with party rules."

Source:
LOST BY HALF A PERCENTAGE POINT
Sanders Wants a Recount in Kentucky
14 hours ago
THE LATEST

Bernie Sanders "signed a letter Tuesday morning requesting a full and complete check and recanvass of the election results in Kentucky ... where he trails Hillary Clinton by less than one-half of 1 percent of the vote. The Sanders campaign said it has asked the Kentucky secretary of state to have election officials review electronic voting machines and absentee ballots from last week's primary in each of the state's 120 counties.

Source:
×