I posed an important question in an AMA Viewpoints post two weeks ago: Would the bipartisan legislative policy for repealing Medicare’s sustainable growth rate (SGR) formula turn into a missed opportunity? For Congress, it certainly did. For physicians, the story is more complicated.
The U.S. Senate’s vote Monday evening passed yet another temporary Medicare payment patch, sent to them from the U.S. House of Representatives. That means physicians’ Medicare payments will not be hit with the 24 percent cut that was scheduled to take effect Tuesday. The 12-month patch will extend the current 0.5 percent update through the end of the year and freeze payment rates for the first three months of next year.
While this action is hardly surprising—Congress now has passed 17 such patches over the past 11 years—it is incredibly disappointing.
For the first time ever, both chambers and parties in Congress agreed on legislative policy for solving this perennial problem once and for all. They spent more than a year working together on legislation that would repeal the SGR formula and lay the foundation for a higher performing Medicare system. This was remarkable progress, especially in a legislature so often paralyzed by politics.
For the first time ever, Congress had two real options when the latest patch expired: Either they could default to business as usual and pass another temporary patch, or they could eliminate the need for these destabilizing patches and choose reform.
Everyone knew that Congress would never allow a devastating 24 percent payment cut to take place. In fact, several members of Congress even quoted a Wall Street Journal editorial that calls the SGR cuts a budgeting “sham” that Congress always postpones. Rather, the issue lies in the fact that Congress gave up this much-needed opportunity to repeal the SGR formula at last.
Up until the final hour, multiple members of Congress spoke publicly about the need for reform, and several bills that used the agreed-upon SGR repeal policy were put forth. The problem was that the bipartisan collaboration that had characterized the policy development phase collapsed when it came to paying for the legislation. The various funding sources brought forth were so politically polarizing that some of the proposals never even made it to a vote.
We continued to urge Congress to resume bipartisan, bicameral collaboration to reach agreement on an acceptable way to pay for repeal. But this step appears to be one they were unwilling to take, letting their political interests trump good policy choices.
In the face of broad opposition from medical organizations against simply defaulting to another short-term patch, the House relied on procedural maneuvering to quickly approve the 12-month proposal on a voice vote. The Senate followed suit after objections were raised to considering bills that included the bipartisan, bicameral reform proposals. Both chambers failed to seize a historic opportunity.
In contrast, we physicians made the most of this opportunity. We embraced a spirit of unity and achieved many important milestones for Medicare reform by emailing, calling and speaking in person with our members of Congress. Together with our patients, we completed more than 1,158,000 emails and phone calls as well as 500 face-to-face visits. Among our achievements were:
- A bipartisan majority in Congress—141 Republicans and 118 Democrats—signed a letter to their leadership urging full SGR repeal.
- Committees from both chambers of Congress worked together to create legislative policy that would repeal the SGR formula and offer considerable improvements over current law.
- The three committees of jurisdiction completed successful bipartisan mark-up of the legislation, which came before the full Congress.
- 118 members of the House co-sponsored the original repeal bill; 51 of those members decided to become co-sponsors following our National Day of Action for SGR Repeal and National Advocacy Conference.
While we are disappointed that the fight for SGR repeal must continue, we are in a far better place to advance reform than we were a year ago. Rest assured that the AMA will continue to press for the changes we need to ensure our practices are sustainable and our patients have reliable access to the care they need.
