A 21-percent cut in Medicare payments for doctors is scheduled to take effect April 1 and congressional leaders have plenty of reasons to step in and prevent it: Policy-wise, the cut could cause serious access-to-care problems if doctors stopped seeing Medicare patients, as many have threatened to do. Politically, no lawmaker wants to be on the wrong side of the powerful doctors lobby in a tough election year.
Add to this list a third item: Such a cut would undermine the Medicaid reforms that Democrats are highlighting as part of their just-passed overhaul of the health delivery system. Here’s how:
Right now, Medicaid rates are well below those of Medicare. Indeed, researchers at the Urban Institute reported last year that doctor payments under Medicaid are about 72 percent of those under Medicare. As a result, many doctors refuse to see Medicaid patients at all — an ugly trend because Medicaid patients, being the lowest income, tend also to be the most vulnerable.
Recognizing the access problem, Democrats threw a provision into their health reconciliation bill that would hike Medicaid rates for primary care services to at least the level of Medicare rates. A 21-percent pay cut under Medicare, though, would basically nullify the advantage of ending the pay disparity between the programs — because there would hardly be one.
No one thinks the Medicare cut will happen. Both the House and Senate have already passed bills providing a temporary fix, and it’s likely that Senate lawmakers will pass the House proposal this week after they wrap up debate on the reconciliation bill. That would delay the Medicare cut for another month, allowing lawmakers more time to consider the Senate’s seven-month fix. It’s not the permanent solution that the doctors lobby wants, but it gets Congress through the mid-term elections.