Lawmakers kicked off a two-day hearing on the perennial question of how to forestall Medicare’s physician payment cuts Wednesday by discussing how to pay for a compromise struck in the 113th Congress. But prospects for a package of offsets that could satisfy both parties remained murky.
Neither Democrats nor Republicans moved much beyond their talking points at the House Energy and Commerce Health Subcommittee hearing, even as they urged Congress to move forward with replacing the oft-criticized sustainable growth rate formula, or SGR. A temporary payment patch (PL 113-93) blocks cuts to Medicare doctors through March 31.
Subcommittee Chairman Joe Pitts, R-Pa., used the hearing to make a case for why the policy compromise reached last year by the three committees of jurisdiction must be paid for. Full committee Chairman Fred Upton, R-Mich., and some of the panel’s witnesses also urged Congress to use the offset as a way to advance other changes to Medicare.
“The most pro-beneficiary reform that we can adopt this Congress are ones that will not only remove the threat of SGR but also shore up the Medicare program with sensible reforms that make the program more sustainable for years, perhaps generations, to come,” Upton said.
Alice Rivlin, co-chairwoman of the Bipartisan Policy Center’s Delivery System Reform Initiative, said lawmakers have a “historic opportunity to do two things at once”: replace the SGR, ending the pattern of patches, and “begin phasing in new payment incentives that will nudge Medicare — and, indeed, I believe the whole health system — toward high-quality, more cost-effective delivery of care.”
Former Sen. Joseph I. Lieberman, I-Conn., outlined potential savings from his Medicare proposal with former Sen. Tom Coburn, R-Okla., including familiar suggestions such as combining the program’s Part A and Part B into a single deductible and raising the eligibility age.
But Democrats pushed back against Republicans’ arguments that the legislation must be paid for, noting that the House passed legislation (HR 30) earlier this month to change the definition of full time from 30 to 40 hours under the health care law (PL 111-148, PL 111-152) without an offset for its $53 billion cost. They pledged to oppose any offsets that increase burdens on Medicare beneficiaries, advocating for revenue to be put on the table.
“The flawed SGR formula has plagued our health care system for too long, but a fix to SGR that harms Medicare beneficiaries because of an insistence on offsets that reduce benefits and limit access is not an acceptable tradeoff,” said Gene Green of Texas, the top Democrat on the Health Subcommittee.
Still, lawmakers continued to urge both parties to move beyond their battle lines. New York Democrat Eliot L. Engel said Democrats and Republicans must “take our blinders off,” while Oregon Democrat Kurt Schradersuggested that lawmakers put together a task force to pick the “least offensive” offsets.
“We can pass it in a partisan vote if necessary,” said Texas Republican Michael C. Burgess, noting that there are currently more Republicans than when the House passed the policy agreement last year with an offset that delayed the health care law’s individual-mandate penalties.
“But how much better would it be if we all sat down and did that very, very difficult, very troublesome, very nettlesome work of providing the offset and made this a meaningful and lasting solution to a very nettlesome problem.”