GOP Threatens Pay Cut For Medicare Doctors Unless Democrats Delay Key Obamacare Provision

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The GOP-controlled House of Representatives will vote this week to tie bipartisan legislation that would prevent an average 24 percent pay cut for doctors who treat Medicare patients to a multi-year delay of the Affordable Care Act’s individual mandate. Even a one-year delay of the mandate is expected to reduce the number of Americans signing up for ACA plans and raise Obamacare premiums by more than 10 percent next year.

In 1997, Congress passed a law establishing the so-called “Sustainable Growth Rate” (SGR) formula to determine federal reimbursement rates for Medicare doctors. The adopted formula proved to be far too draconian, as it would institute steep cuts to doctors’ payment rates, raising concerns that fewer physicians would accept Medicare patients. Congress has consequently voted to delay the cuts every year since they were adopted — but has yet to establish a permanent “doc fix” for the underlying formula.

Failing to pass a doc fix at all — temporary or otherwise — could be disastrous for seniors on Medicare, who could face a landscape where fewer numbers of doctors are willing to treat them.That’s why Republicans such as Rep. Paul Ryan (R-WI) have stated that “[We must] fix the Medicare physician payment formula for the next ten years so that Medicare beneficiaries continue to have access to health care.”

Initial reports suggested that a bipartisan group of lawmakers were on the cusp of actually agreeing on a permanent, $138 billion fix this year. But Congress remained stalled on a how to pay for the legislation.

That’s where the GOP’s newest proposal comes into play. The Congressional Budget Office (CBO) has estimated that a one-year delay in the individual mandate would yield about $9 billion in savings for the federal government, and that delaying it for longer would save even more money.

However, the move would also increase Obamacare premiums and discourage people from buying insurance. That could lead to less efficient and diversified risk pools in the Obamacare marketplaces and stymie reform during the health law’s nascent years — and physicians’ groups agree that it’s the wrong approach to paying for the doc fix, especially considering this is the first time in years that Congress has agreed on the broad strokes for permanent reform.

“The only way this is going to get done if it’s done in a bipartisan fashion,” said Christian Shalgian, director of advocacy and health policy for the American College of Surgeons, in an interview with The Hill. “I don’t think this pay-for was developed in a bipartisan fashion.”

“We cannot support linking SGR repeal to changes in current law that will result in fewer people getting health insurance coverage,” added Molly Cooke, president of the American College of Physicians, in a statement last week. “We call on House and Senate leadership to immediately engage in a bipartisan process to reach bipartisan agreement on a budgetary solution that can pass both the House and the Senate.”