H.R. 3961: Medicare Physician Payment Reform Act

H.R. 3961

Medicare Physician Payment Reform Act

Sponsor
Rep. John D. Dingell

Date
November 19, 2009 (111th Congress, 1st Session)

Staff Contact
Communications

Floor Situation

H.R. 3961 is being considered under a closed rule.  The rule provides that following its passage, the Clerk will be directed to append the text of H.R. 2920, the Statutory PAYGO bill that passed the House on July 22, 2009, to the legislation before sending it to the Senate.  The legislation was introduced by Rep. John Dingell (D-MI) on October 29, 2009.

 

Bill Summary

H.R. 3961 provides for an increase in Medicare physician reimbursements for 2010 equal to the increase in medical inflation, and recalibrates the Sustainable Growth Rate (SGR) mechanism such that year 2009 physician expenditures shall be used as the new baseline for computing whether total physician payments exceed the SGR targets.  The bill establishes two separate conversion factors-one for evaluation and management services, including primary care and preventive services, and one for all other services provided.  Thus evaluation and management services and all other specialist services would receive different annual payment rates, based on the growth of each service over time; the former would also receive a higher conversion factor under the bill-GDP growth plus two percent for evaluation and management services, as opposed to GDP growth plus one percent for all other services.  Finally, the bill allows accountable care organizations established to opt-out of the national expenditure targets created in the bill and establish their own organization-specific targets.

 

 

Background

As part of spending reforms included in the Balanced Budget Act of 1997, Congress enacted a sustainable growth rate (SGR) mechanism for Medicare physician payment levels.  The SGR mechanism is designed to balance the previous year's increase in physician spending with a decrease in the next year, in order to maintain aggregate growth targets.  In light of increased Medicare spending in recent years, the statutory formula has resulted in negative annual updates.  While an imperfect formula, the SGR was designed as a cost-containment mechanism to help deal with Medicare's exploding costs. 

While Democrats claim Speaker Pelosi's 1,990-page health "reform" bill (H.R. 3962) is "deficit-neutral," the hundreds of billions of dollars in new spending in H.R. 3961 is not paid for.  While Members may support reform of the SGR mechanism, many may oppose what amounts to an obvious attempt to hide the apparent cost of health "reform" by introducing separate legislation to repeal the SGR mechanism without paying for this more than $200 billion increase in federal spending in its first ten years.  Moreover, H.R. 3961 would permanently alter the SGR mechanism, and an independent analysis of official data conducted by former Medicare public trustee Tom Saving found that a permanent reversal of these current-law reductions, if not paid for by appropriate offsets in spending, would increase Medicare's unfunded obligations by nearly $2 trillion over a 75-year period.  Due to these significant concerns about rising deficits and higher federal spending, a bipartisan majority in the Senate recently rejected similar legislation (S. 1776) designed to increase physician payments over the next 10 years that did not include any offsetting spending reductions.

Press reports indicate that the Democrat majority desires to pass a stand-alone "doc fix" bill in order to help facilitate passage of its broader health "reform" initiative.  A CQ Today article noted that omitting an SGR "fix" from the Democrat health "reform" legislation "could free up billions of dollars that Democratic leaders could apply to make other changes in a health care plan"-making it easier for the majority to pass its government takeover of health care.  Therefore, some may view a vote for H.R. 3961 that is not paid for through appropriate spending reductions as helping to facilitate a government takeover of health care, with all its flaws: More than $700 billion in job-killing new taxes, regulations that will raise premiums for millions of Americans, and creation of a government-run health plan causing as many as 114 million Americans to lose their current coverage.

In its rollout of the Pelosi bill, the Democrat majority released a one-page document claiming that "a previous Congress established the policy for paying Medicare doctors, so the update for 2010 is not a new policy to be paid for."  By this logic, future Congresses will not have to pay for any increases in federal deficits and spending associated with the Pelosi health "reform" bill-directly contradicting President Obama's pledge that his bill would not increase the federal deficit by one dime.  Regardless, many may note that adding hundreds of billions in new spending will be paid for-by America's children and grandchildren, through mountains of new federal debt.

Cost

The Congressional Budget Office earlier this year estimated that a full SGR repeal would cost $285 billion over ten years.  However, the Administration has already begun the process of "reforming" the SGR by hiding approximately $80 billion of a repeal's cost (the amount of the SGR attributed to physician-administered drugs) into the budgetary baseline as "current law"-even though some have questioned the Administration's authority to do so.  Therefore, CBO scores H.R. 3961 as increasing the deficit by nearly $210 billion, though as stated earlier, the full impact of a long-term SGR "fix" approaches nearly $300 billion.

Members may particularly note that because seniors pay for one-quarter of total physician spending through their Medicare Part B premiums, CBO also notes that H.R. 3961 would raise seniors' Medicare premiums by nearly $50 billion over ten years.   These premium increases would be on top of the 20 percent increase in Part D prescription drug premiums as a result of the Pelosi health care bill.