SGR, CHIP fixes potentially on lame-duck agenda, but prospects look slim

The only major task likely to get done during the four-week lame-duck session that Congress started Wednesday will be to provide continuing funding for the federal government, which is slated to run out of money Dec. 11.

That funding effort will include debate over the Obama administration’s request for $6.2 billion in funding to fight the current Ebola outbreak in West Africa and prepare for future cases in the U.S. Most political observers expect there to be broad consensus around the need for additional Ebola funding, but the amount of the appropriation and where those dollars are targeted is likely to change as Congress scrutinizes the proposal.

Beyond that limited agenda, there doesn’t appear to be much appetite to take on other healthcare policy issues. “I believe that the lame-duck session is going to be limited to measures that are either emergencies like Ebola or must do’s to keep the government open,” said Chip Kahn, CEO of the Federation of American Hospitals. “I don’t see a lot being done.”

But that isn’t stopping various healthcare groups from pushing for action on their agenda items. The American Medical Association and its allies are pushing for Congress to pass legislation during the lame-duck session permanently repealing and replacing Medicare’s sustainable growth-rate formula for physician payment. Last year, Congress reached a bipartisan, bicameral agreement on a permanent repeal-and-replace bill but no agreement on how to cover the roughly $140 billion cost over a decade. Failure to reach a deal on financing led to a 17th straight patch that expires at the end of March. If there’s no temporary or permanent fix then, physicians will face a 21.2% reduction in pay.

“We’re encouraged by where we’re starting from,” said Dr. Robert Wah, the AMA’s president. “We’ve already got bicameral, bipartisan legislation.”

Earlier this month, the GOP Doctors Caucus of House members sent a letter (PDF) to Speaker John Boehner (R-Ohio) and Majority Leader Kevin McCarthy (R-Calif.) calling on them to take up SGR reform during the post-election session. “We understand that discussions with the Senate have been derailed in the past by disagreements over offsets, but those negotiations must resume,” the 19-member group wrote. “We appreciate that hard decisions must be made on how to offset this proposal.”

There is a similar push to extend funding for the Children’s Health Insurance Program during the lame-duck session. The program, which has enjoyed bipartisan support in the past, is set to run out of money at the end of September 2015. Advocates, including the Medicaid and CHIP Payment and Access Commission, argue that leaving CHIP in limbo heading into next year could cause states to restrict eligibility for the program, which currently provides coverage to roughly 8 million lower-income kids. They also say shifting CHIP beneficiaries to Obamacare exchange plans could create disruptions in coverage and care. But extending the program for four years, as proposed by retiring Sen. Jay Rockefeller (D-W.Va.), would cost nearly $90 billion.

Federally qualified community health centers, which also have received bipartisan support in the past, face a similar funding cliff at the end of this fiscal year. They’ll lose $3.5 billion in federal dollars through the Patient Protection and Affordable Care Act if Congress doesn’t extend the funding. Last month, a bipartisan group of more than 300 legislators signed a letter calling for an extension.

“The discussions that we’ve had leads me to believe that a bipartisan coalition is coming together to address the health center funding issues,” said Dan Hawkins, policy director for the National Association of Community Health Centers. “There are folks on both sides of the aisle who recognize the seriousness of the problem.”

But few political observers share that optimism about prospects for healthcare policy changes during the lame-duck session. That’s in part because there will be little time to take up difficult issues that involve spending tens of billions of dollars, and the track record of the current split Congress doesn’t offer much evidence to suggest they’ll make much progress on legislation. That’s compounded by the outcome of the elections, with Republicans winning a majority in the Senate to gain full control of Congress. They’ll likely be preoccupied with distributing gavels and preparing a legislative agenda for January. Republicans and Democrats would have a tough time agreeing on where to get the money to pay for these healthcare provisions.

Thomas Scully, who served as CMS administrator under President George W. Bush, figures that there’s a “1 in 10 million” chance of a permanent SGR repeal passing during the lame-duck session. “I’d be surprised if there’s anything of significance that happens outside of” funding the federal government, said Scully, who’s now a lobbyist with Alston & Bird.

Rick Pollack, the American Hospital Association’s executive vice president for advocacy and public policy, is similarly skeptical about the prospects of pulling together an SGR deal or reauthorizing CHIP in the lame-duck session. “Whatever they do in these four weeks on anything really has to be bipartisan and bicameral,” Pollack said. “If there isn’t a deadline staring at them in this environment, it makes it difficult for something to be addressed.”

Republican leaders also will face pressure from their right flank to hold off on taking up major healthcare policy issues in the lame-duck session, when Senate Democrats still would be able to share in writing the bills. Nina Owcharenko and Robert Moffit, healthcare policy analysts at the conservative Heritage Foundation, warned against jamming through deals on SGR and CHIP during the short session in a recent column.

“These are serious health policy questions that need to be untangled,” Owcharenko said. “I don’t think a lame-duck Congress, where they throw everything into a mixing bowl and have at it, is really a prudent approach.”

But the AMA’s Wah worries that if a deal doesn’t get done in the lame-duck session, it will derail all the bipartisan work that was done last year to reach an SGR repeal bill that both chambers and both parties signed off on. “We’ve obviously seen this movie many, many times,” Wah said. “But we’re optimistic that this time it’s going to end better.”

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