Experts Question 'Doc Fix' As Reid Threatens Weekend Work On Bill With COBRA, Medicare Provisions

Politico: Experts are questioning the virtues of the three-year Medicare "doc fix" that would stave off cuts to Medicare doctors' pay but set up a larger fight down the road. ... In health policy circles, the 'doc fix' has become emblematic of Washington's worst habits: a potentially solvable policy problem run amok for about a decade now, bogged down in pure politics and accounting gimmicks. The 'doc fix,' a last-minute infusion of funds to head off a looming doctor pay cut under Medicare, hits the floor this week via the tax extenders bill ..."

"Without the fix, reimbursement rates to doctors would be cut by 21 percent starting June 1. The problem, many say, is that the "Sustainable Growth Rate," which sets the formula for reimbursement for doctors, assumed that a 1990s slowdown in physician payments would continue. The opposite happened. "The problem first became apparent in 2002, when Medicare costs outpaced the SGR. A Republican-led Congress stepped in with extra funding the following year, preventing a reduction in doctor payments. Congress has continued to do so for seven years now" (Kliff, 5/25).

The Hill: The bill that the "doc fix" is attached to — a package of tax cut "extenders" — also includes mandated drug discounts to hospitals that treat the poor. "The new language would require that discounts be provided for patients who don't have prescription drug coverage, a substantial change from the earlier provision that would have mandated discounts for all patients. Sources said they expect the drug industry to support it. The Pharmaceutical Research and Manufacturers of America (PhRMA) is not commenting on the legislation. … Under current law, drug makers must offer deep discounts to federally qualified health centers and other places that serve poor patients — but only for outpatient care." It would "only cost the federal government about $35 million over 10 years" which is relatively uncontroversial, however the passage of the broader, more expensive tax entender package "remains in doubt." The package also includes an extension of COBRA health insurance subsidies for newly laid-off workers (Pecquet, 5/24).

CongressDaily: As the House prepares to act on the legislation Tuesday or Wednesday, Senate Majority Leader Harry Reid is hinting that he may keep the Senate in session this weekend to finish work on the bill. "House Ways and Means Chairman Sander Levin said floor consideration could slip to Wednesday, leaving little time for the Senate to act. And if any changes enter the picture during Senate floor debate, the bill would have to come back to the House."

In the meantime, lawmakers are preparing a short-term fix for COBRA subsidies and the Medicare physician payment fix if action slips (Cohn, 5/25).

Related, earlier KHN coverage: How The Tax Bill Would Affect Medicare, Medicaid And COBRA Subsidies (Villegas, 5/21).

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