The bipartisan effort to repeal the flawed sustainable growth rate (SGR) formula is hitting political obstacles, as Republicans in the U.S. House of Representatives move to pass a version of repeal legislation that includes amendments linking the fix to the Patient Protection and Affordable Care Act (ACA).
House members are expected to consider a bill on March 14 that would delay the enforcement of penalties for the ACA's individual mandate for five years -- and use the savings to pay for a repeal of the SGR formula. The amended bill is HR 4015, the SGR Repeal and Medicare Provider Payment Modernization Act.
Starting on April 1, payments to physicians under Medicare will be cut by 24% due to the SGR formula unless Congress acts yet again to avert it.
The House's move is agitating both House and Senate members, according to Cynthia Moran, assistant executive director for government relations at the American College of Radiology (ACR). Last month, both bodies approved a joint version of SGR repeal legislation that combined the Senate's S 2000 bill and the House's HR 4015, but this new House Republican version threatens that, she said.
"House Republicans want to delay the ACA's individual mandate and use it to pay for SGR repeal, but the combination of the two means that this legislation will be dead on arrival at the door of the Senate," Moran told AuntMinnie.com.
The leader of the Democratic majority in the Senate, Harry Reid (D-NV), said the House bill had "no credibility," and the White House said President Obama would veto the legislation if it made it to his desk, Reuters reported.
In response to the House's latest effort, the Senate is now putting together an updated version of its SGR repeal legislation that it expects to discuss on the floor next week, Moran said. The Senate has not included any "pay fors" in its repeal proposals.
"Senate Democrats have said they don't need to include 'pay fors' in SGR repeal legislation, and that the SGR can be retired without them," Moran said.
Senate Republicans aren't happy. In fact, in a speech on the Senate floor on March 12, Finance Committee Ranking Member Orrin Hatch (R-UT) said efforts by Senate Democrats to advance bipartisan, bicameral legislation to fully repeal and replace the broken Medicare SGR formula without finding money from elsewhere to pay for it were "another partisan political ploy."
"Democrats want to pass a bill that has a roughly $177 billion price tag without even trying to offset any of the cost," Hatch said in a press release. "Sadly, these same Democrats don't seem to care that they've quickly turned what was a true, bipartisan accomplishment into another partisan political ploy."
Medical groups aren't happy, either. On March 13, Dr. James Madara, CEO and executive vice president of the American Medical Association (AMA), sent a letter to congressional leaders voicing the organization's strong opposition to the House Republicans' SGR fix.
"On behalf of the American Medical Association, I am writing to profess our profound disappointment that a strong bipartisan, bicameral effort to repeal the Medicare sustainable growth rate has become a victim of partisan approaches to resolve budgetary issues," he wrote. "Short-term remedies that continue to support a failed policy are no longer acceptable."
Despite the political haggling, both houses of Congress want to permanently repeal the SGR, according to Moran. It's figuring out how to pay for it that exposes the chasm between Republicans and Democrats and the House and the Senate.
"It's all posturing," she said. "And what will happen is that Congress will enact yet another patch -- although for how long, it's unclear. Will they do a patch that takes this to mid- to late-November, through elections? Or will they do one that goes for 12 months? Senate Republicans hope they will be in charge at that point."
