Congress ‘doc fix’ would halt big drop in Medicare fees

Washington – The U.S. House of Representatives hopes to unveil a proposal this week that would end years of tension and bickering between Congress and the nation’s doctors.

“We have a lot of physicians very worried, looking at what’s going on in Washington,” said Matthew Katz, CEO of the Connecticut State Medical Society.

What’s at stake is a 21 percent cut in the fees doctors receive from their Medicare patients that will take effect on March 31 unless Congress acts.

The reduction is a result of a 1997 deficit reduction law that set Medicare doctor fees through a formula based on economic growth, known as the “sustainable growth rate,” or SGR. That worked for a few years but eventually the formula resulted in pay decreases, angering doctors.

Congress responded to each prospective cut in doctor fees by approving temporary adjustments to the formula.

But this time, Congress may approve a permanent “doc fix.”

“We are happy to see that they are seeing the benefit of a permanent solution instead of kicking the can down the road, then picking it up and kicking it again,” Katz said. He also said that if Congress does not stop the impending cuts in fees, some physicians in Connecticut may decide they can’t afford to treat Medicare patients.

While some specialists, like pediatricians, have few or no Medicare patients, about 25 percent to 30 percent of the patients treated by Connecticut doctors as a whole are on Medicare, Katz said.

Meanwhile, Ariel A. Gonzalez, director of AARP’s Health and Family Advocacy Team, says doctors’ threats of dropping Medicare patients “has been highly exaggerated.”

He also said the AARP is very concerned about the way House Republicans propose to pay for some of the cost of the permanent doc fix, which is estimated at about $200 billion over 10 years.

The proposal, which has not been released in detail yet, would cover $35 billion of that cost by making two changes in the Medicare program.

“That $35 billion would be paid for on the backs of Medicare beneficiaries,” Gonzalez said.

The proposal would require those who purchase Medigap policies that supplement Medicare’s basic coverage to pay a $250 deductible before receiving full coverage for a doctor visit.

The proposal would also hike, by 15 percent, the cost of  premiums paid by high-income Medicare recipients.

Gonzalez said some of the highest-income Americans, who would have to pick up 80 percent of the cost of their premiums, would quit the Medicare system in favor of private insurance, “leaving behind a lower-income, sicker population.”

There are about 600,000 AARP members in Connecticut.

The proposal initially had bipartisan backing in the House.

Reps. Paul Ryan, R-Wisc., and Sander Levin, D-Mich, the chairman and top Democrat on the House Ways and Means Committee, said on Friday, “We are now engaging in active discussions on a bipartisan basis — following up on the work done by leadership — to try to achieve an effective permanent resolution to the SGR problem, strengthen Medicare for our seniors, and extend the popular Children’s Health Insurance Program.”

But concerns by AARP and other groups may undercut some of that support, especially on the Democratic side of the aisle.

Rep. John Larson, D-Conn., a member of the Ways and Means Committee, is reserving judgment for now.

“While discussions are ongoing, I continue to urge both sides of the aisle to work together towards developing a permanent solution to replace the flawed sustainable growth rate formula,” he said.

The Senate has not yet weighed in on the House plan.

Children’s health, too

The House package also includes a $5 billion two-year extension of the Children’s Health Insurance Program past its current Sept. 30 expiration date. CHIP provides basic funding for the HUSKYB program that pays for the health care of children who live in moderate-income households.

The Connecticut Department of Social Services says about 13,530 children are served by the HUSKYB program.

CHIP is a joint federal-state program, with Connecticut paying 45 percent of the cost of the program and the federal government paying 65 percent.

But the Affordable Care Act provided a boost to the funding the federal government would give the states. The package would authorize that boost, beginning on Oct 1, so that Connecticut’s share would drop to 12 percent and the federal government’s share would rise to 88 percent

“Continued funding for CHIP is essential,” Gov. Dannel Malloy wrote congressional leaders last year.

“Failure to preserve CHIP funding will jeopardize continued coverage for children in demonstrated need for these supports and necessarily exposes states to significant budget constraints,” the governor said.

Voices for Children is among the child advocates who have been pressing Congress to extend the CHIP program.

It’s good that Congress is not waiting for the last minute to do so, said Sharon Langer of Connecticut Voices for Children.

“We’re in the middle of a budget session, so it would be really good for states to know how much they will get in CHIP funding,” she said.

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