Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Medicare Physician Payment Reform in Doubt, Despite House Passage

Before recessing for a week, last Friday the House voted 238-181 to pass H.R. 4015, legislation to replace the Medicare Sustainable Growth Rate (SGR) framework for physician reimbursement with a transitional mechanism leading to a more permanent physician payment structure based on performance and quality. However, the provision included by House Republican leadership to help pay for the $138.4 billion cost of the legislation was a delay for five years of the Patient Protection and Affordable Care Act’s (PPACA) individual mandate. The Congressional Budget Office (CBO) estimated the savings at $169+ billion over ten years. House Minority Leader Nancy Pelosi (D-CA) summed up the move as follows: “The Republicans’ fixation with destroying the health security of millions of Americans through their efforts to destroy the Affordable Care Act imperils the permanent doc fix, and that must stop….” House Ways and Means Committee Chairman Dave Camp (R-MI) responded: “The President, realizing the failures of his health care law, has repeatedly delayed and exempted certain individuals, labor unions and businesses from the law’s mandates and penalties. If the President is willing to give relief to some, he and Democrats in Congress should be willing to give all Americans a reprieve from ObamaCare. It is only fair.” The White House also weighed in with a Statement of Administration Policy (SAP) which includes a veto threat. Senate Finance Committee Chairman Ron Wyden (D-OR) has said his priority is to pass the permanent legislation before the end of this month when current law would force a 24% reduction in physician payment rates. However, if the Senate is unable to pass the legislation with a payfor suitable to the House Republican conference, then another temporary reprieve may be added to the docket next week. Senator Orrin Hatch (R-UT), who has urged both parties to negotiate a bipartisan offset, conceded that the irresolution could result in a “nine month fix” before a post-election solution is reached. Both House and Senate Republicans have rejected Democrat efforts to use as an offset the funding left over from the Iraq/Afghanistan wars which would come from the Overseas Contingency Operations (OCO) account and the CBO has not been willing to recognize OCO funds as scorable savings. It remains to be seen what moves Senate Majority Leader Harry Reid (D-NV) may take to bring S. 2110 to a vote in the Senate when it reconvenes. That legislation contains the bipartisan SGR reform language as well as Medicare/Medicaid extensions, podiatric physician provisions, and other health related provisions.

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