Before leaving for spring recess, the House
passed groundbreaking legislation to permanently repeal the flawed formula the government uses to reimburse doctors for treating Medicare patients. Since 2003, Congress has had to vote something like 17 times to temporarily "fix" the payments to avoid massive cuts to those payments. So this legislation would permanently fix it, and probably would have before the Senate went out of recess had Majority Leader Mitch McConnell
held a vote then. But he postponed until the Senate comes back after recess, which creates some problems.
Problem number one: Congress will have just two days to either finalize this bill and get it to President Obama for a signature or come up with a temporary patch before payments to physicians are cut. The actual deadline was March 31, but the government said it could limp along for a few more weeks to avoid making the cuts. By a few weeks, they meant April 15 and the Congress doesn't come back until April 13.
The other problem is that this two weeks has given senators—and others—time to find out about all of the extra stuff added to this bill and how it's actually funded. There are the things raised last week:
Some Democrats had raised issues about abortion restrictions embedded in the "doc fix" deal, while others wanted to see a longer reauthorization of the Children's Health Insurance Program. On the Republican side, there are a few senators who remained uneasy last week with the cost of the deal, which stands to add to the federal deficit in the short run.
Then there's how the fix is paid for, even though that has
gotten short shrift in traditional media accounts. Senior advocacy groups are not behind this bill—even though they also want the doc fix—because it includes some structural changes to Medicare going forward that open the door for more privatization and much more cost-sharing by beneficiaries, which amount to Medicare cuts. It also increases the means testing that's already in place in the program, making higher income individuals who already pay higher premiums foot more of the bill. That's better than making more people pay more, but it's potentially destabilizing to the program and to its public approval. So it's basically $35 billion in cuts to Medicare beneficiaries, some cuts to providers, and no "skin in the game" from other stakeholders, namely insurers and drug companies. As in, insurers and drug companies don't have to come up with a penny.
The House has basically jammed the Senate, or McConnell jammed himself by not acting last week by dropping this bill with such a short deadline. The announcement from the administration that there is such a short window for the Senate to act could do the trick and force passage of this bill. It would mean trading one annual time-bomb, the doc fix, for a mess of others in pending Medicare changes.