Our guest blogger is Mandy Krauthamer Cohen, executive director of Doctors for America.

On Thursday night, the House voted to reverse the 21% pay cut to physicians that went into effect on June 1st. While physicians everywhere appreciate the fact that the House stopped the hemorrhage of the SGR pay cut by voting for the Senate version of the “doc fix”, the fact that it is only a 6 month temporary solution is extremely distressing. What started out as a three and a half year “fix” when it was first introduced in May – with allowances for primary care to grow at higher rate – was whittled away over the past month to a six month temporary fix that expires on December 1st.

When are we going to stop kicking the can down the road and permanently fix the SGR – or at least lay the foundation to make a permanent fix fiscally feasible? The House was able to muster the support for a permanent “doc fix” back in 2009 – though that support has likely vanished as the election draws closer and any mention of the word deficit sends everyone into a tailspin. The Senate voted down a permanent fix for the SGR last year –clearly this is an uphill battle.

While Washington continues to play politics – it is the seniors, military families and physicians who care for them that are caught in the middle. The baby boomers begin entering Medicare in six months, and these new Medicare patients may have difficulty finding a doctor as it is. According to the AMA, about one in four Medicare patients looking for a new primary care physician are having trouble finding one. About one in five physicians are already limiting the number of Medicare patients they treat because of the instability and uncertainty of Medicare payment.

The constant uncertainty about Medicare payment is not only difficult for physicians financially – particularly internists, family physicians and geriatricians — but it also engenders cynicism of government among physicians. Given, that the new reform legislation will greatly increase demand for physicians’ services through expansion of insurance coverage, it doesn’t seem like the best time to be provoking skepticism among physicians.

I was pleased to watch President Obama’s weekly address on June 12th where he discussed the need for a permanent fix for the SGR. He backed that up with his statement last night after the House vote:

OBAMA: I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problems without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely. I look forward to working with Congress to achieve that goal, and I’m gratified that in the meantime they’ve taken the provisional step of blocking this pay cut.

Good stuff – but it’s time to turn those supportive statements into action. We can’t wait until Thanksgiving before we continue the dialogue on how to move to a more permanent payment solution — this issue is too complex, expensive and laden with pitfalls. It’s time to get to work.

Over in the comments section of this post, Texas Aggie makes smart observation about another factor that could be driving the Republicans to oppose the health care law:

You may have missed an important point in the analysis of the Republican reaction and why they are so adamantly opposed to universal health care. Back when Clinton was trying to get it through, the Republicans realized that if the Democrats got credit for something that would turn out to be as popular as universal health care, then the Republicans were finished as a viable political party. They decided to not just modify Clinton’s proposals but to destroy them.

The same fact holds today. They know that if health care is implemented, that they are finished for the next generation or two, and they are desperately fighting like trapped rats.

The sentiment may be overstated, but it’s certainly worth considering. During the Clinton era, Republicans followed historical precedent and battled health care reform in the legislative arena. They defeated the bill and saved their party, so to speak. In the past, when they couldn’t defeat a major bill they opposed, they would simply switch their votes and take credit for it. For instance, in that interview with Lester Feder, James Morone recalls how “in the original [Medicare] vote in the House, the legislation passed by some 45 or 46 votes. It got exactly 10 Republican votes in the House. But that was on a preliminary vote on a parliamentary maneuver to stop it from being buried back in committee. When that vote failed, almost all Republicans then crossed over and supported Medicare.” “The thinking was that they had lost, and they wanted to take credit for legislation that was likely to become popular,” Morone explains.

This time may be unique because Republicans didn’t ultimately switch their votes; they simply took their battle into implementation. And if they’re truly interested in protecting their viability and discrediting health care reform, they will have at least 50 different entry points at which they can slow down the process. Whether voters realize (and the president highlights) what that says about them as a party, is a different matter.

Last month, independent analysts in California discovered that WellPoint “overstated future medical costs” to justify its 39% premium increases in the individual health market and committed numerous other methodological errors and now, Aetna has also withdrawn a filing with California insurance regulators “after discovering it had made calculation errors.” “The company had requested a 19% average rate increase, due to go into effect July 1 and covering 65,000 individual policyholders, but said its actuaries found mistakes in how the annual cost of monthly premiums was calculated, among other things,” the Wall Street Journal reports.

A thorough review of insurance rates across the country will likely produce many more of these mathematical anomalies, but as Scott Paltrow details in a new CAP paper few states actually have the authority to block or question large premium hikes in the individual and/or small group markets. In many states, Paltrow explains, insurers have used their money and clout to lobby against tougher review regulations and consequently, states can do very little to protect patients from unreasonable premium increases. “Records show that large health insurers have been major contributors to candidates for state offices. Four of the biggest health insurers—Wellpoint, UnitedHealth Group, Humana, and Aetna— contributed $8.7 million to candidates for state offices and state campaign committees in 42 states from 2005 through 2008, according to a 2010 report by the National Institute on Money in State Politics,” Paltrow writes.

Here is a taste of their influence:

- 23 states do not review and approve premium changes before insurance companies put the changes into effect.

- 30 states and the District of Columbia do not review and approve premium changes to small employer policies before they go into effect.

The health care law changes some this. Health insurance issuers will have to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase and that information will be “prominently” displayed on their Internet websites. The federal government will encourage states to conduct rate review by offering grants and states themselves can decide to block certain insurers with a poor history of rate increases from participating in the exchanges. The incentives and extra funding are certainly there, but ultimately, very little is done to diminish the insures’ influence over this whole process. Today, even in states that have rate review, “state regulators and others who monitor state regulation say that regulators even in these states often wave through requested hikes—often because of political pressure by large insurers.” The grants will allow reviewers to bolster their staffs, but will it free them from the political pressure?

Paltrow suggests, and many Democrats agree, that Congress should consider passing Sen. Feinstein and Rep. Schakowsky’s legislation giving the Health and Human Services Department secretary the power to block excessive premium increases. But I suspect this won’t happen unless the insurers really take advantage of the weak review provisions and premiums spiral out of control.