The U.S. House of Representatives today rejected a Senate bill that would have averted a 27.4 percent Medicare physician payment cut scheduled for Jan. 1 and extended an expiring payroll tax reduction and unemployment insurance benefits. The net result was to leave 2012 Medicare payment rates in limbo.
Votes on H.R. 3690. As originally passed by the House Dec. 13 by a vote of 234-193, the House’s version of the bill would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But as a result of disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.
On Dec. 17 the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies—including current Medicare physician payment rates—for two months. The rationale for the short-term extension was to avoid disruptions on Jan. 1 and provide time for further negotiations on financing longer-term extensions.
House action on Dec. 20. Following the Senate’s action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. In the most important vote, the House approved by a vote of 229-193 a resolution that disagrees with the Senate and calls for appointing members to a House-Senate conference committee, which is charged with working out differences between the two versions of the bill.
Prior to the House votes today, Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays with the understanding that they could be called back to Washington, D.C., on short notice.
At this time, it does not appear likely that the outstanding issues will be resolved before Jan. 1.
Outlook for January. On Dec. 19 the Centers for Medicare & Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days—until Jan. 17—to avoid processing payments at the lower rate. After that date, claims will be processed on a first-in, first-paid basis at the reduced rates until the situation is resolved.
The House currently is scheduled to return to Washington on Jan. 17, while the Senate is scheduled to return on Jan. 23. However, there are reports that the House may move the date of its return up to Jan. 3.
AMA views. The AMA issued strong statements following the House and Senate votes, reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal the flawed and disruptive formula once and for all.
Throughout the year, the AMA has been pursuing a strategy to repeal the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep.
Throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nevertheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families who rely on TRICARE—they and their physicians deserve better.
The AMA will provide additional updates on the status of the 2012 payment rates as events unfold. With the expectation that Congress will be in recess, we will defer any new grassroots messaging until after the holidays.
New grassroots messages will be available after Jan. 1 or earlier if Congress decides to return to Washington between the holidays. Physicians can always view the AMA’s latest grassroots messages and reach their federal legislators by telephone using our toll-free physicians grassroots hotline number: (800) 833-6354.