{"id":465325,"date":"2010-03-24T06:00:56","date_gmt":"2010-03-24T10:00:56","guid":{"rendered":"http:\/\/washingtonindependent.com\/?p=80175"},"modified":"2010-03-24T06:00:56","modified_gmt":"2010-03-24T10:00:56","slug":"on-health-care-reform-a-major-step-remains","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/465325","title":{"rendered":"On Health Care Reform, a Major Step Remains"},"content":{"rendered":"<div id=\"attachment_80182\" class=\"wp-caption alignnone\" style=\"width: 490px\"><a href=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2010\/03\/health-care-signing.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-80182\" title=\"Obama signs health care bill\" src=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2010\/03\/health-care-signing-480x341.jpg\" alt=\"President Obama signs the health care reform bill on Tuesday. (ete Marovich\/ZUMApress.com)\" width=\"480\" height=\"341\" \/><\/a><\/p>\n<p class=\"wp-caption-text\">President Obama signs the health care reform bill on Tuesday. (Pete Marovich\/ZUMApress.com)<\/p>\n<\/div>\n<p>With President Obama <a href=\"http:\/\/www.denverpost.com\/frontpage\/ci_14739730?source=rss\">having  signed<\/a> an enormous, $938 billion health reform proposal into law  Tuesday, it\u2019s tempting to imagine that the long-drawn and ubiquitous  debate over health care legislation is over for a while.<\/p>\n<p>If  only it were so.<\/p>\n<p><div id=\"attachment_3087\" class=\"wp-caption alignleft\" style=\"width: 140px\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-3087\" title=\"congress\" src=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2008\/08\/congress.jpg\" alt=\"Image by: Matt Mahurin\" width=\"130\" height=\"130\" \/><\/p>\n<p class=\"wp-caption-text\">Image by: Matt Mahurin<\/p>\n<\/div>\n<div class=\"floatButtons\">\n<div style=\"float: left; margin-right: 10px; margin-bottom: 10px;\"><script src=\"http:\/\/digg.com\/tools\/diggthis.js\" type=\"text\/javascript\"><\/script><\/div>\n<div style=\"float: left; margin-bottom: 10px;\"><script type=\"text\/javascript\"\n\tsrc=\"http:\/\/d.yimg.com\/ds\/badge2.js\"\n\tbadgetype=\"square\">\n\t<?php the_permalink(); ?><\/script><\/div>\n<div style=\"float: left; margin-right: 10px;\">\n\t<script type=\"text\/javascript\">\ntweetmeme_source = \"TWI_news\";\ntweetmeme_service = \"bit.ly\";\n<\/script> <script src=\"http:\/\/tweetmeme.com\/i\/scripts\/button.js\" type=\"text\/javascript\"><\/script>\n<\/div>\n<div style=\"float: left;\"><a name=\"fb_share\" type=\"box_count\" href=\"http:\/\/www.facebook.com\/sharer.php\">Share<\/a><script src=\"http:\/\/static.ak.fbcdn.net\/connect.php\/js\/FB.Share\" type=\"text\/javascript\"><\/script><\/div>\n<\/div>\n<p> Neither the bill that was signed  yesterday nor the accompanying reconciliation proposal moving through  the Senate this week addresses the <a href=\"http:\/\/blogs.wsj.com\/health\/2008\/07\/10\/why-medicare-pay-cuts-for-doctors-will-be-back\/\">flawed  formula<\/a> that dictates physician payments under Medicare &#8212; one of  the most agonizing and expensive problems facing the entire health  delivery system. The omission has left doctors facing a 21-percent cut  in their Medicare payments at the end of the month; it&#8217;s threatened  Medicare patients with access-to-care problems; and it&#8217;s inspired the  powerful doctors lobby to undertake an all-out blitz in search of a  permanent formula fix. It&#8217;s also put Democratic leaders in the odd  position of celebrating the historic significance of their health care  overhaul, while at once plotting a strategy to prevent doctors from  suffering huge cuts not addressed by those reforms.<\/p>\n<p>At  issue is the 13-year-old formula &#8212; the so-called Sustainable Growth  Rate (SGR) &#8212; that was designed to prevent Medicare doctor payments from  skyrocketing by indexing reimbursements to the growth of the economy on  the whole. Trouble is, health care inflation has grown by degrees  faster than GDP in recent years. Indeed, the SGR has called for cuts in  doctors\u2019 Medicare pay every year beginning in 2002. That\u2019s a perennial  thorn in the side of Congress, which, having no stomach for alienating  the powerful physician lobby, almost always steps in with a temporary  fix.<\/p>\n<p>This year, though, the temporary fix also  threatens to alienate the AMA.<\/p>\n<p>&#8220;The AMA cannot  support proposals that aim to address only the most imminent threat to  payments levels and patient access, with no regard for the future of the  Medicare [program],&#8221; AMA President James Rohack <a href=\"http:\/\/www.ama-assn.org\/ama1\/pub\/upload\/mm\/399\/sgr-letter-hr4691.pdf\">wrote<\/a> to Senate leaders earlier this month. &#8220;We are opposed to further  short-term patches of any duration.&#8221;<\/p>\n<p>Lawmakers on  both sides of the aisle are well aware of the problem. Speaking to  reporters at the Capitol last Friday, House Speaker Nancy Pelosi  (D-Calif.) said that a permanent doc-fix remains &#8220;very important&#8221; to  Democrats. \u201cIt&#8217;s not in this bill, but we will have it soon,\u201d Pelosi  said. \u201cWe have made a commitment to do this.\u201d<\/p>\n<p>The  issue is hardly partisan, nor will it have any effect on the larger  reform bills recently passed by the Democrats. But the fix doesn&#8217;t come  cheap. Indeed, a bill <a href=\"http:\/\/washingtonindependent.com\/68462\/house-passes-medicare-doc-fix\">passed  by the House<\/a> in November would scrap the SGR altogether, replacing  it with a formula designed to ensure that doctors&#8217; Medicare payments  reflect the true cost of delivering care. Pricetag: $210 billion.<\/p>\n<p>It  was that cost &#8212; which wasn&#8217;t offset with new revenues or cuts elsewhere &#8212; that caused the budget hawks of the Senate <a href=\"http:\/\/washingtonindependent.com\/64698\/senate-shoots-down-permanent-doc-fix-bill\">to  shoot down<\/a> a similar proposal a month earlier. And it was that cost  that caused Democrats &#8212; who&#8217;d vowed both to keep their reform package  below $1 trillion and to offset the entire tab &#8212; to strip the doc fix  from the larger reform bills.<\/p>\n<p>The issue has left  Democrats in a pickle: In an election year, they don&#8217;t want to alienate  the AMA. But with voters already weary of deficit spending, nor can they  borrow another $210 billion to fund a permanent fix.<\/p>\n<p>&#8220;Any  way you look at it, I don&#8217;t see how they get 60 votes [in the Senate],&#8221;  said Julius Hobson, former AMA lobbyist and now a senior policy analyst  at the Washington law firm Bryan Cave.<\/p>\n<p>Lawmakers  don&#8217;t have much time. On April 1, Medicare payments to doctors are  scheduled to fall, on average, by 21 percent. Both the House and Senate  have recently passed bills to delay the cut temporarily &#8212; the House by  one month and the Senate by seven months. But when Senate Democrats  tried Friday to adopt the House bill by unanimous consent, Republicans  refused.<\/p>\n<p>A spokeswoman for Senate Majority Leader  Harry Reid (D-Nev.) said Tuesday that Democrats will likely try that  strategy again this week, after they&#8217;ve finished the debate over the  health reconciliation bill. Complicating matters, Congress is scheduled  to leave Friday for spring recess, and won&#8217;t return to Washington until  April 13. That timetable leaves open the possibility that Congress would  have to tackle the 21-percent cut retroactively &#8212; an uncertainty that&#8217;s  been a thorn in the side of doctors trying to manage their businesses.<\/p>\n<p>&#8220;For  the physicians in actual practice,&#8221; Hobson said, &#8220;this is a nightmare.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>President Obama signs the health care reform bill on Tuesday. (Pete Marovich\/ZUMApress.com) With President Obama having signed an enormous, $938 billion health reform proposal into law Tuesday, it\u2019s tempting to imagine that the long-drawn and ubiquitous debate over health care legislation is over for a while. If only it were so. Image by: Matt Mahurin [&hellip;]<\/p>\n","protected":false},"author":4315,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-465325","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/465325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/4315"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=465325"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/465325\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=465325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=465325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=465325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}