published Friday, March 21st, 2014

Congress confronts Medicare cuts to doctors' fees

Local and national coverage

WASHINGTON — Hope is fading for a Capitol Hill drive to permanently fix Medicare's outdated payment formula and spare doctors from automatic cuts in their fees next month. Now the question is whether lawmakers can regroup and come up with a short-term solution when the current patch expires.

Even though there's widespread support for bipartisan legislation to repair, once and for all, the broken Medicare formula -- it threatens doctors with a 24 percent cut in their Medicare payments -- there's no agreement on how to bear the 10-year, $140 billion cost.

A bill in the GOP-controlled House that combines the so-called doc fix with a delay in imposing penalties on individuals who fail to purchase health care under the health care law is dead in the Democratic-controlled Senate. Without the individual mandate, fewer people would enroll in the program, generating $170 billion in savings over 10 years.

In the Senate, meanwhile, a bill to address the problem is likely to be killed by Republicans because it won't be paid for. There has been discussion of claiming savings from reduced war spending, but Republicans and most budget experts regard that as a phony reduction.

That leaves Congress with little choice but to, yet again, address the outdated formula with a temporary fix. The formula dates to a 1997 budget law but soon proved to be fundamentally flawed. Congress has stepped in, usually for a year at a time, to prevent doctors from absorbing fee cuts.

House Majority Leader Eric Cantor, R-Va., said in a memo to fellow GOP lawmakers on Friday that the issue is one of the "must-do items" when Congress returns next week from a one-week recess.

A Cantor spokesman, Douglas Heye, said it is possible the House would take up legislation to temporarily repair the payment formula. Senate action is unlikely before the current fix expires on March 31. As a practical matter, the deadline to act is April 10, when Congress leaves for a two-week spring recess.

When Congress has blown the deadline in the past, Medicare has dealt with the problem by simply delaying processing payments until the formula had been raised.

Lawmakers had hoped to do a permanent fix this year because lower health care inflation has shrunk the estimated cost of permanently fixing the payment formula. But coming up with offsetting spending cuts is proving too difficult. The three-month fix that passed in December was designed to keep the pressure on Congress to find a permanent solution.

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