Medicare fees to drop sharply as Senate falters on ‘doc fix’ bill opposed by CT senators

Updated at 10:43 a.m. Friday

Washington –  The Senate’s failure to act on a bill, opposed by Connecticut’s senators, means fees paid to doctors who treat Medicare patients will drop sharply at the end of the month.

The House voted overwhelmingly for the bill, which would prevent a 21 percent declined in payments, beginning April 1. But unanimous agreement could not be reached in the Senate to take up the bill before Congress left on a two-week break.

The Centers for Medicare and Medicaid Services says it takes about two weeks to pay claims from doctors, and if Congress acts as soon as it returns, the government may be able to avoid the fee cuts.

But there’s no guarantee of swift action when Congress returns on April 13, especially since some senators, including Connecticut’s Democratic Sen. Chris Murphy, say they want to amend the House-passed bill. That would require the bill to be sent back to the House for approval.

Connecticut’s five House members voted Thursday for the legislation; but Murphy and Connecticut’s other Democratic senator, Richard Blumenthal, say they oppose the bill because of an anti-abortion provision and how the legislation would extend a children’s health program.

Organizations that represent physicians had hoped the Senate would act.

“The American Medical Association (AMA) is extremely disappointed that the U.S. Senate did not vote on the Medicare and CHIP Reauthorization Act before leaving for recess today,” said AMA President Robert Wah in a statement released Friday. “Their failure to act leaves physicians facing a devastating 21 percent cut in Medicare reimbursements…”

Matthew Katz, CEO of the Connecticut State Medical Society, warned of a “damaging impact on the seniors of this nation.”

The legislation, known as the “doc fix” bill, would also fund community health centers for two years, so House Republicans included language in the bill that would prevent federal funds to those clinics to be used for abortions.

The anti-abortion language, known as the Hyde Amendment, is included every year in spending bills and sunsets at the end of each fiscal year. But Democrats like Blumenthal object to the restriction’s being applied to a multi-year bill that would extend the Hyde amendment into the next Congress and the next administration.

“I have great reservations about the expanded Hyde amendment and its impact on women’s health,” Blumenthal said. “Right now I’m disposed to vote against it.”

The Community Health Center Association of Connecticut issued a statement Thursday saying it is “grateful to the House — and especially our five representatives” — for approving the bill. Like the nation’s doctors the association had hoped for quick action on the bill by the Senate. It says  health centers serve 342,000 Connecticut residents annually, or about one out of every 11 people in the state.

If Congress does not approve the bill, the Community Health Center Association said, the state’s facilities would lose more than $$22.5 million in federal funding on Oct. 1.

“Our senators, Richard Blumenthal and Chris Murphy, have been tremendous champions of federally qualified health centers over the years, and [the centers] and their patients need their continued support,” the Community Health Center Association said. “While there may be philosophical disagreements over some of the language included in [the bill], specifically the Hyde amendment, that language restates existing restrictions; it is not a change from current policy and will in no way impact access to services for health center patients.”

Meanwhile, Connecticut’s House members lauded the bill’s approval in a 392 to 37 vote in the House of Representatives.

“This legislation represents a bipartisan compromise to finally fix Medicare’s broken reimbursement system that has threatened seniors’ access to care, caused uncertainty for doctors and failed taxpayers for much of the past two decades,” said Rep. Jim Himes, D-4th District. “While the bill is far from perfect, it moves us toward rewarding quality, providing better coordination of care and ensuring seniors get the care they need when they need it.”

Rep. Elizabeth Esty, D-5th District, said, “I have heard from doctors throughout northwest and central Connecticut who want to focus on practicing medicine and delivering quality care rather than worrying about the near-annual threat of drastic cuts.”

 A broken formula for doctors

A formula developed in 1997 that set Medicare doctor fees through a formula based on economic growth, known as the “sustainable growth rate,” or SGR, is the reason for the current crisis in Medicare fees, which if not resolved could prompt some Connecticut doctors to drop their Medicare patients,  Katz said

The formula worked for a few years but eventually resulted in pay decreases, angering doctors. Congress responded  by approving temporary adjustments to the formula. But this time, Congress is trying to permanently fix the program, at a cost of  about $200 billion over 10 years.

“I am pleased that Democratic and Republican leadership came together to negotiate a balanced solution to the Medicare reimbursement rate issue that has plagued Connecticut doctors since 1997,” said Rep. Joe Courtney. D-2nd District. “Seventeen times, Congress has enacted one-year stopgap measures to prevent cuts to providers, and this bill would finally end the annual threat of draconian cuts.”

The Medicare Access and CHIP Reauthorization Act of 2015 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 about 13,530 children who live in moderate-income households.

Approval of the bill would also help state finances.

CHIP is a joint federal-state program, with Connecticut paying 45 percent of the cost and the federal government paying 65 percent. But, as of Oct. 1, the doc fix bill would dramatically cut Connecticut’s share to 12 percent while hiking the federal government’s share to 88 percent.

Like the nation’s doctors, and community clinics, child advocates have lobbied Congress to approve the bill.

But Blumenthal and Murphy — and other Senate Democrats — prefer a four-year rather than two-year CHIP authorization.

“I’m glad we’re having a discussion about how we can reform the way Medicare reimburses Connecticut physicians,” Murphy said. “But I’m concerned by the fact that this legislation only reauthorizes CHIP, the program responsible for providing health insurance for Connecticut’s most vulnerable kids, for two years. A two-year authorization just doesn’t cut it for kids in Connecticut — they deserve more stability around their access to health care.”

Sharon Langer, advocacy director at Connecticut Voices for Children, said a four-year authorization is  preferable. But she also said the current bill improves the CHIP  funding formula and makes other reforms in the program. Langer said he would like to see the Medicare Access and CHIP Reauthorization Act pass the Senate instead of a competing GOP proposal that would make cuts to the  program.

The bill “is good for children’s health and for the state budget,” Langer said.

Although supporters of the legislation say it will shore up Medicare, the AARP and other organizations that represent seniors oppose it.

That’s because about $35 billion to pay for some of the cost of the doc fix would come from an increase in Medicare rates for wealthier beneficiaries and a new deductible for Medigap policies.

 

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