AFTER years of failed attempts and growing complaints, lawmakers from both parties finally banded together Wednesday, April 15 as Congress approved legislation that permanently recasts how Medicare will reimburse physicians.
Fueling the bill’s overwhelming support was backing from potent interest groups, including the American Medical Association and AARP, the lobby for senior citizens.
Though AARP tried unsuccessfully to change the bill to ease costs for some Medicare recipients, CEO Jo Ann Jenkins hailed its passage as “momentous,” adding that it would help Medicare beneficiaries “rest assured that they’ll be able to keep seeing their physicians each year.”
The Senate gave final congressional approval late Tuesday, April 14 to the $214-billion, 10 year bipartisan measure, which rewrites how Medicare pays doctors for treating over 50 million elderly people through Sustainable Growth Rate (SGR). It also provides extra money for health care programs for children and low-income families, a provision the Democrats coveted, and imposed greater costs on some higher-income beneficiaries, which Republicans claimed a victory.
Most immediately, the bill prevented a 21 percent cut in those physicians’ Medicare fees, which would have hit home Wednesday when a federal agency planned to start making payments reflecting that reduction. That act would have ensured a flurry of complaints from both doctors and senior citizens, whom lawmakers dearly wanted to avoid.
“This bipartisan bill will protect health coverage for millions of Americans, and I will be proud to sign it into law,” said President Barack Obama shortly after the Senate vote. “It’s a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their healthcare needs.”
The final Senate vote cast late Tuesday night was 92-8, with all eight “no” votes from Republicans.
“Instead of kicking this important Medicare payment issue down the road again, a strong bipartisan majority in Congress voted to finally solve the problem and ensure that seniors on Medicare don’t lose access to their doctors,” said Senate Majority Leader Mitch McConnell (R-Ky).
Among next year’s presidential candidates, Sens. Ted Cruz (R-Texas) and Marco Rubio (R-Fla.) voted against the bill, while ophthalmologist Rand Paul (R-Ky.) and Lindsey Graham (R-S.C.) supported it.
Meanwhile in the House of Representatives, the vote was an overwhelming yes, 392 to 37. The House approved the legislation last month, after the bill’s compromise was crafted by House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif). Their joint effort marked an uncharacteristic accord to address a long-awaited problem that both sides wanted to be resolved.
“[This bill is] the first real entitlement reform in two decades,” Boehner commented.
For congressional leaders, including Mitch McConnell, passage provided an opportunity to demonstrate that the parties can work together and govern.
“It’s another reminder of a new Republican Congress that’s back to work,” he said.
The bill’s chief feature was its annulling of a 1997 law aimed at slowing the growth of Medicare that has repeatedly threatened deep cuts in reimbursements to physicians, and ultimately led to doctors threatening to stop treating the federal program’s beneficiaries.
“This has been a long ordeal that a lot of us have worked on for a long time,” said Senate Finance Committee Chairman Orrin Hatch (R-Utah) ahead of the vote, calling it a “major, major accomplishment.”
Since 2003, Congress has blocked 17 reductions, which often calls for intense lobbying and difficult choices about finding budget savings that both parties detested. Lawmakers had tried before to void the old formula, but have fallen short over disagreements typically over how to pay for a new reimbursement system.
The newly-approved, 300-page bill would create a better, more efficient payment system with financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits.
Before the measure cleared the Senate, lawmakers banded together and rejected six amendments—three from each party. Approval of any changes could have doomed the bill by unraveling the careful compromise between Boehner and Pelosi.
By 58-42, the chamber rejected an effort by conservatives to force Congress to find enough savings to pay for the whole measure without increasing federal red ink. As written, two-thirds of the bill’s costly price tag was financed by making big federal defects larger still. McConnell and GOP leader John Cornyn were among 12 Republicans who opposed the amendment by Sen. Mike Lee (R-Utah).
The votes showed most senators’ opposition to portions of the bill, including an amendment by Sen. Patty Murray (D-Wash.), beefing up programs for women’s health, and a proposal by Sen. Michael Bennet (D-Colo.) that would provide four years of extra money for the Children’s Health Insurance Program instead of two.
The bill will cost $214 billion over 10 years, with $73 billion of that cost offset with spending cuts or new revenue, according to the Congressional Budget Office (CBO). The bill also “includes reforms to transition Medicare’s payment system from incentivizing quantity to quality in care, and is likely to produce small savings for the government over time,” the CBO said.
Conservative groups like the Heritage Foundation pointed out that the Medicare agency’s actuary warned last week that Congress may need to pass more legislation down the road, to ensure that doctors do not lose out in the second decade of the law.
Citing a federal law, the Centers for Medicare and Medicaid Services stopped processing fee claims two weeks ago, giving lawmakers time to complete the legislation. The agency processes around 4 million Medicare doctor payments a day.
(With reports from Associated Press, The Hill)