The GOP’s revised budget proposal does surprisingly little to make good on the party’s pledge to defund the entirety of the Affordable Care Act (even though it does make significant cuts to existing health programs), but the Hill’s Michael O’Brien is reporting that Republicans is in no way resting on the issue. In fact, House Speaker John Beohner (R-OH) is telling reporters that GOP members will offer several amendments to stop the flow of federal dollars to the act:

Boehner said there’s “been a lot of discussion” about possibly adding to the GOP’s continuing resolution an amendment by Rep. Steve King (R-Iowa) that would end any automatic funding to implement President Obama’s new health reform law.

“I expect that there will be a lot of amendments, and there’s been a lot of discussion about that particular amendment,” Boehner said on conservative pundit Laura Ingraham’s radio show. [...]

“We’re going to do everything that we can in this bill to make sure there’s no money in Obamacare,” Boehner explained. “Within the rules of debate, over a bill like this, we’re going to do everything we can to make sure there’s no money.”

Last year, Democrats went to great lengths to distinguish between discretionary spending and mandatory spending in the law, arguing that it would be easier for the GOP to go after the former — funding that has not yet been appropriated — than the latter, which they would have to literally take back. Right now it’s still unclear if the GOP will attempt to go through the extra Congressional hurdles to reverse mandatory spending (that’s already being spent on things like establishing temporary high risk insurance pools, tax credits for small businesses offering health coverage, the early retiree reinsurance program, and the state-based exchanges), but the distinction may ultimately be mute. We’re dealing with a very motivated House majority that will use any and all tools at their disposal — including government shut-down — to achieve their goal of eliminating funding.

Democrats, meanwhile, can ask some pointed questions about why the GOP is taking away coverage from 12,000 chronically sick individuals in high risk pools and increasing taxes on employers taking advantage of the early retiree grants and small businesses receiving tax credits.

Reading through the news stories about President Obama’s $3.7 trillion budget blueprint, one thing becomes clear: the administration didn’t want to use the document to reignite the health care debate or make waves by overtly asking for new implementation dollars for the Affordable Care Act. And so its biggest piece of health care policy — as far as I can tell — is to delay cuts in physician reimbursement rates in the Medicare program. The Hill’s Julian Pecquet has the details:

The budget proposal would postpone for two years a scheduled 25 percent cut in the Medicare physician payment formula, known as the Sustainable Growth Rate (SGR), that’s set to go into effect at the end of the year. The $62 billion “doc fix” would be paid for by “changes that squeeze Medicare and Medicaid payments to hospitals and doctors and expand the use of generic drugs in federal health programs,” according to The New York Times.

Physicians’ groups are lobbying for a permanent repeal of the SGR, and it’s not clear how they’ll respond to a two-year solution. In any event, the proposed offsets are almost certain to attract considerable criticism when the administration releases additional details on Monday.

Indeed, the AMA and most health policy wonks have been clamoring for a fix to the Sustainable Growth Rate (SGR), which came to life in 1997 as a means of controlling health care spending. According to the formula, the amount Medicare pays doctors for an average Medicare patient can’t grow faster than GDP. In 2002, medical inflation outpaced economic growth and Congress stepped in to avert the cuts and has been doing so ever since. Each year the problem just piles onto itself – so what was a 2% cut back in 2002 has mushroomed exponentially into a 25% cut.

The medical community has been pressuring Congress to stop kicking the can down the road and permanently fix the SGR but the cost of the endeavor — estimated north of $245 billion — has made a fix politically unfeasible. In 2009, the House mustered the support for a permanent “doc fix” but the effort has gone nowhere in the Senate, even as Republicans continue to argue that Democrats should have addressed the problem in the Affordable Care Act.

Obama’s two-year respite sounds like a good political compromise — it takes the politically toxic issue of the table for two years and gives doctors some relief from the anxiety of looming reimbursement cuts.