House Medicare 'doc fix' vote likely Thursday amidst disputes about cost, role in health reform

Nov 18 2009

"On Thursday, the House is expected to pass a $210 billion measure — known as the 'doc fix' — that will adjust Medicare payment rates to avoid a 21 percent cut in January and continuing cuts in the years ahead," The New York Times reports, adding: "The House originally included the provision in its big health care bill. But it was dropped because its steep cost would have meant the bill would add to future federal deficits, violating one of President Obama's central requirements for the health legislation."  A similar, standalone bill was blocked last month in the Senate by all Republicans, a dozen Democrats and an independent (Herszenhorn, 11/17).

"The physicians' lobby is optimistic a permanent Medicare physician payment fix that failed in the Senate will pass the House this week, former American Medical Association President Nancy Nielsen said today," CongressDaily reports. "Should the permanent fix pass the House, Nielsen said the group will redouble its efforts in the Senate and attempt to convince deficit hawks that temporary fixes are adding to the problem, causing the cuts to inflate each year" (Edney and House, 11/17).

The so-called "doc fix" has nevertheless been tied to reform: "A proxy fight is now shaping up around physician payment. Democrats have an incentive to … push a permanent solution through Congress," Kaiser Health News reports. Doctors gave their support - and critical momentum - to the broader House reform legislation that passed earlier this month, but it's not clear whether the support will continue without a permanent pay fix. Congress has been addressing the issue only one year at a time, leaving in place an unpopular formula that mandates the cuts. Republicans, meanwhile, are hoping to force Democrats to include the "doc fix" in their sweeping reform legislation (Weaver, 11/17).

Failure to pass some form of the doc fix could mean some doctors would begin refusing to see new or current Medicare patients because the reimbursement would be so low, the Associated Press reports. "As a result, the legislation enjoys support among lawmakers in both political parties, although there has been little if any public acknowledgment of its impact on seniors enrolled in Medicare." That impact would likely mean that "[s]eniors would pay $49 billion in higher premiums over the next decade"  (Espo, 11/17).