Several months of sustained legislative progress on physician payment reform has been stopped in its tracks by an add-on.
U.S. House representatives today approved by a 238-181 margin an amended version of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015), which now includes language stipulating that no American would be subject to a penalty tax for failure to obtain government-approved health insurance -- known as the individual mandate -- until 2019.
Dave Camp, chairman of the House Ways and Means Committee, authored the amendment.
Absent a resolution to the Sustainable Growth Rate mechanism, Medicare doctors face a 24 percent reimbursement cut. H.R. 4015, in its original form, would permanently repeal the SGR formula and provide physicians with a 0.5 percent pay increase for five years while alternative payment models based on incentives and value-based care phase in.
Current "bridge" legislation, signed by President Obama in January, prevents the SGR pay cut from going into effect until March 31. Physician groups had hoped both houses of Congress would pass -- and the president would sign into law -- a permanent resolution by then.
It now appears that will not happen because of the linkage of the mandate delay to the SGR bill.
"Tying SGR repeal to what will be the 51st vote in the House to repeal or scale back the Affordable Care Act needlessly politicizes an important issue that enjoys widespread bi-partisan support," said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. "Delaying the individual mandate will not pass in the Senate. Instead of working together to find a way to pay for SGR repeal legislation, this political approach increases the likelihood of another temporary patch. A patch will only compound the high price tag of SGR repeal and impede efforts to modernize and improve the Medicare physician payment system."
Gerald Kominski, PhD, director of the UCLA Center for Health Policy Research, agreed that partisan politics are at play.
"The House is committed to repealing or seriously damaging Obamacare at every opportunity. This is yet another opportunity to do that. The two issues are completely unrelated," Kominski, a former staff member of the Medicare Payment Advisory Commission, told Medical Practice Insider.
He continued, "It's difficult to assess whether this is a genuine attempt at staking out an extreme position and then seeking a compromise, or whether it is a continuation of the tactics the House has engaged in now for several years … It's unfortunate that the SGR issue is getting caught up in the politics of Obamacare because resolution to the problem is essential and long overdue."
The office of House Majority Leader Eric Cantor, who called today's vote, did not respond to a request for comment.
Camp's amendment states, "The Obama Administration has put the American people through plan cancellations, loss of their doctors, increased premiums and deductibles, and a failed website. Simple fairness requires that the American people should not further suffer the consequences of problems they did not create."