Congressional Leaders Discuss Medicare 'Doc Fix, ' Payroll Tax Break & Washington Sentinel

Mon Dec 19 23:39:42 PST 2011

Description: Description: Description: Description: CAL/AAEM: California
Chapter of the American Academy of Emergency Medicine

December 15, 2011

Congressional Leaders Discuss Medicare 'Doc Fix,' Payroll Tax Break 

CaliforniaHealthline
<http://www.californiahealthline.org/articles/2011/12/15/congressional-leade
rs-discuss-medicare-doc-fix-payroll-tax-break.aspx#ixzz1gjlXKEn0> 

On Wednesday, House Speaker John Boehner (R-Ohio) met with Senate Majority
Leader Harry Reid (D-Nev.) and Senate Minority Leader Mitch McConnell
(R-Ky.) to discuss strategies for extending a payroll tax break and delaying
scheduled reimbursement cuts to Medicare physicians, Politico reports.

The three emerged from the meeting without a deal. Boehner said Reid and
McConnell will have to work out certain details between themselves
(Raju/Sherman, Politico, 12/14).

The meeting comes after the House on Tuesday voted 234 to 193 to pass a
GOP-helmed payroll tax cut extension (HR 3630). The bill would extend a
$1,000 payroll tax break that is set to expire at the end of 2011.
Meanwhile, the "doc fix" would stave off a nearly 30% cut to Medicare
physician payment rates that is scheduled to take effect on Jan. 1, 2012.
Instead, the legislation would increase reimbursement rates by 1% over the
next two years. 

The plan would pay for the $38 billion fix in part by increasing Medicare
premiums for high-income beneficiaries and by redirecting funding from the
federal health reform law that was intended for prevention and public health
services.

The bill's chances for passage in the Senate are slim, as Senate Democrats
worry that the cost of the tax break extension will fall on middle-income
residents. Senate Democrats were considering paying for the measure with a
surtax on high-income individuals.

Certain Democrats and President Obama also oppose a provision in the House
bill that would push ahead the stalled Keystone XL oil pipeline project.
Some lawmakers said that if the GOP agrees to eliminate the pipeline
provision and if Democrats agree not to levy the surtax, the parties could
soon reach an agreement on a revised plan (California Healthline, 12/14).

According to Politico, Democrats on Wednesday discussed dropping their
demand for the surtax, but it is unclear if Republicans would offer any
concessions in exchange (Politico, 12/14).

Kyl Wants Permanent Doc Fix

Meanwhile, Senate Minority Whip Jon Kyl (R-Ariz.) has been lobbying
lawmakers to develop a proposal to permanently fix the sustainable growth
rate formula, which determines the scheduled reimbursement cuts, National
Journal reports. 

According to Kyl, the cost to offset such legislation is not real because
the SGR only estimates hypothetical savings. He said the cost typically
cited for offsetting an SGR repeal is a budget gimmick that represents the
savings Congress would have if it had obeyed the formula. However, since
lawmakers have delayed scheduled cuts for years, the government has not
secured any of the savings, negating much of its repeal cost.

Kyl said he is not sure whether he can get Senate Republicans to commit to
passing such legislation at the moment (McCarthy, National Journal, 12/14).

Reimbursement Cuts Could Happen, Physician Advocate Fears

On Wednesday, American Academy of Family Physicians President Glen Stream
said that physicians by now are numb to the threat of reimbursement cuts but
that they should keep in mind that the pay reductions actually could happen,
Healthcare Finance News reports.

Stream said physicians' detachment from the current doc fix debate is
"concerning because I think there's a very serious chance that this cut
could go into place and yet many practicing physicians have heard this years
and years in a row, and it always seems to get averted at the last minute."
He added, "I think they may not understand the gravity of the situation this
time" (Bouchard, Healthcare Finance News, 12/14).

However, sources say CMS could briefly delay the rate cut if lawmakers do
not reach an agreement on doc fix legislation before the scheduled cuts take
effect. The agency previously has held physician payments for a brief period
while lawmakers finalized deals to delay the rate cuts (California
Healthline, 12/12).

Lawmakers Also Consider Omnibus Spending Bill

Republicans on Wednesday introduced a House omnibus spending bill (HR 3671)
derived from a House-Senate conference report containing nearly $1 trillion
in fiscal year 2012 spending initiatives, National Journal reports
(House/Goldmacher, National Journal, 12/14). Lawmakers face a government
shutdown if they do not replace the stopgap spending bill that expires on
Friday (Pear, New York Times, 12/14).

Republicans have accused Democratic leadership of delaying action on the
spending package until the payroll tax and doc fix legislation is addressed.
However, Democrats have denied those allegations (House, National Journal,
12/13).

The conference report includes nine unfinished 2012 appropriations bills,
including those funding HHS and providing disease aid and recovery
assistance (House/Goldmacher, National Journal, 12/14). The House and Senate
nearly agree on the conference report aside from a few issues, such as House
Republicans trying to prohibit the District of Columbia from using local tax
revenue to pay for abortions under Medicaid (New York Times, 12/14).

Boehner said the House took the conference report and made it a bill because
lawmakers agreed on the appropriations. He said, "We believe that the
responsible thing to do is to move on this" (House/Goldmacher, National
Journal, 12/14). However, Reid said the agreement was not final, noting
"There are still major issues, critical issues, to be ironed out" (New York
Times, 12/14).

In addition, White House officials said that President Obama also has
problems with a number of provisions in the report and that Congress should
pass a short-term continuing resolution so that the parties can take their
time considering a larger package.

Analysts said Republicans wanted to move ahead with a vote so they can force
Democrats to either accept the measure or vote it down and cause a
government shutdown. The House Rules Committee is expected to hold a hearing
on the bill as soon as Thursday (House/Goldmacher, National Journal, 12/14).

December 2, 2011

Washington Sentinel 

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Attached is the latest issue of AAEM's Washington Sentinel. The Sentinel is
attached as a PDF file. 

In this issue . . .   

**CMS Final Rule for 2012 Physician Pay Includes 27.4% Pay Cut 

**Investigations into Drug Shortages May Forestall Action on Bills 

**As Berwick Leaves, Tavenner Is Nominated for CMS Administrator

**CDC Survey on ED Use Sparks Discussion

**Short . . .

**From the States . . . 

_________________________________________________

Kathleen A. Ream

Director, Government Affairs

American Academy of Emergency Medicine

E-mail:  aaemgov at aol.com

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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