Infighting Threatens COBRA Subsidy Extension, Medicare Doc Pay 'Fix'

Roll Call reports that infighting over some unemployment benefits and a scheduled "fix" of Medicare physician payments has left Democratic congressional leaders at a "dramatic low" in their relationship. "And while publicly, House and Senate leaders refused to assign blame, the behind-the-scenes story was far different. The deadline for the benefits package had been looming for weeks. But all the advance warning was for naught as the lack of trust between the two chambers escalated and an anti-deficit-spending sentiment among rank-and-file moderates grew. House leaders were forced to strike about $80 billion from their bill, including COBRA health benefits for the unemployed and Medicaid assistance to states. But the bill only came together Thursday evening, and Senate leaders decided they had waited around long enough and headed for the exits."

House Majority Leader Steny Hoyer "confronted Senate Majority Leader Harry Reid (D-Nev.) to ask him what he could clear through the Senate. House aides said Reid suggested shrinking the length of the 'doc fix' for Medicare payments to make the bill cheaper. But the Nevada Democrat still couldn’t guarantee it would pass" (Dennis and Pierce, 6/1).

The Hill reports that the extension of a COBRA subsidy to help the newly laid off afford to keep their former employer's health coverage was dropped from a jobs bill that passed the House last week and awaits Senate action, and other unemployment benefits are now being questioned as well. "'There is a sense that the economy is recovering and this is not a new entitlement,' Rep. Earl Pomeroy (D-N.D.) told The Hill, adding, 'We need to get down to the business of hearing some congressional deliberations in terms of winding down the long-term extensions of unemployment'" payments (Heflin, 5/30).

ABC News: "A missed deadline by Congress may mean many of the country's 44 million Medicare patients will have a harder time finding a doctor -- piquing the frustration of many physicians who already care for these patients."  

The "doc fix" through 2011 is in the House-passed bill, but scheduled cuts are scheduled to begin this week, though the Centers for Medicare and Medicaid Services has instructed its workers to hold claims for payment for 10 days to allow the Senate to act. "There are signs the Medicare payment will be kicked down the road when the Senate returns on June 7. On Friday, the House of Representatives voted 245-171 to pass H.R. 4213, which among other things would freeze the payment cuts until December 2011 — though the move came too late for the Senate to act to pass the legislation. If the payment cuts are delayed, it will not be the first time; Congress has instituted such delays nine times over the past eight years, most recently last April" (Childs, 6/1).

Inside Health Policy reports that extended Medicaid payments for states struggling with surging Medicaid rolls because of the recession are also in limbo after a six-month extension in increased payments was left out of the jobs bill as well. For now, higher payments — first authorized using stimulus funding last year — to states to help them afford Medicaid run through the end of the year. "Extending the enhanced Medicaid payments (known as FMAP) that were part of last year's stimulus package would have cost $24 billion. A source says the House may take up the Medicaid extension — which is strongly supported by state and federal lawmakers, patient advocates and other stakeholders — in June" (Lotven and Coughlin, 5/28).

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