Category: Medicare

“Doc Fix”: The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively (here and here). Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage. Wynne starts by describing the Merit-Based Incentive Payment System (MIPS):

More Criticism of the Medicare “Doc Fix”

From Paul Winfree of the Heritage Foundation:

Rather than a permanent replacement to the Sustainable Growth Rate, it is much more likely that the House doc fix will be shorter term patch requiring another series of patchwork legislation just nine years from now.

From David Hogberg of the National Center for Public Policy Research:

When the Senate returns from recess this week, it will consider the “Medicare Access and CHIP Reauthorization Act” (MACR). The bill has acquired many names such as “The Doc Fix Fix” and “Budget Buster,” but a more appropriate one is “IPAB-lite.”

IPAB — the Independent Payment Advisory Board — was created as part of Obamacare to cut Medicare expenditures whenever those expenditures grew too quickly. Thankfully, IPAB’s unpopularity has thus far prevented it from getting off the ground. Unfortunately, the changes MACR makes to Medicare’s payment system seem very much along the lines of what IPAB would do.

(Readers may be forgiven for wondering when I will let go of this so-called Medicare “doc fix”. We expect a vote in the U.S. Senate tonight – but do not guarantee it!)

From Left and Right; Opposition to Flawed Medicare “Doc Fix”

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples:

Fix The Flawed Medicare Doc Fix

For over a decade, Congress has struggled with an inadequate formula to calculate Medicare payments to physicians.  The formula results in an amount too low to ensure physicians will continue to see Medicare beneficiaries.  At least once a year, Congress has to pass a short-term increase to Medicare physician payments to prevent fees dropping about 20 percent.  The current boost expired on March 31, 2015, and Congress is currently considering legislation, H.R. 2, to fix the problem permanently.

According to a new Issue Brief published by the National Center for Policy Analysis, the currently proposed legislation is a poor doc fix for two major reasons:

Medicare Advantage Plans Become Entrenched

Cheerful Senior Man Having His Blood Pressure TakenThe Centers for Medicare & Medicaid Services (CMS) has announced that payments to Medicare Advantage plans will increase by 1.25 percent next year. Less than a month ago, the plan was to cut payments by 0.95 percent.

Medicare Advantage plans are comprehensive plans that seniors can chose instead of the traditional Medicare Fee-For-Service (FFS) model.Because they are offered by private insurers, Obamacare was supposed to crush Medicare Advantage.

However, this is the third year the Administration has flinched from cuts that would deny people access to these plans. More seniors are in Medicare Advantage today than when Obamacare was passed.

We think Medicare Advantage plans are a good thing, and a foundation for further Medicare reform. So, this development is good news. Further, there appears to be bipartisan agreement that Medicare Advantage is a good thing:

Democrats were wary of a program launched by Bush that they saw as a giveaway to insurance companies.

But as time has passed, support has grown in both parties for the program.

“The worst fears were not materialized,” said Rep. Gerry Connolly (D-Va.), who signed the letter this year against the cuts. “It’s growing in popularity among our constituents and it provides an option.” (Peter Sullivan, The Hill)

Former Bush Official: Medicare “Doc Fix” A Tribute To Big Spender Henry Waxman

Doug Badger, former Deputy Assistant to President Bush on Legislative Affairs, Staff Director of the Senate Policy Committee, and senior official at the U.S. Department of Health & Human Services has harsh words for the so-called Medicare “doc fix” that was rushed through the House of Representatives last month:

The $141 billion health care bill that cleared the House last month and that is expected to win Senate approval next week is a tribute from the GOP-controlled Congress to former Congressman Henry Waxman, a man who worked tirelessly – and with great success – to expand health care-related welfare spending.

The bill (H.R. 2) increases Medicare payments to physicians, largely by replacing one complicated and flawed formula with another. It directs the army of bureaucrats who populate CMS cube farms to soldier on with their futile, half-century-long quest to implement a workable system of administered pricing.

Meanwhile, at the National Journal, Dylan Scott asserts that winning the “doc fix” is “the end for Washington’s most frenzied lobbying extravaganza.” Oh, really? Are all those lobbyists demanding immediate Senate passage of this deficit-financed bill trying to put themselves out of work? I doubt it.

Administration Fears Rejection of Boehner-Pelosi-Obama Medicare “Doc Fix”

As we ease into Easter weekend, the Administration is losing confidence that the Senate will uncritically swallow the Boehner-Pelosi-Obama so-called Medicare “doc fix”.

According to The Hill, the Administration is pleading with the Senate to pass the Medicare Access and CHIP Reauthorization Act (MACRA) immediately when the Senate reconvenes on April 13. If not, the Administration will have to start processing doctors’ claims at a significantly lower rate of payment on April 15.

This pressure mirrors that of Obamacare supporters such as AARP and the American Hospital Association, which are lobbying hard towards the same goal: Recruiting Republican legislators onto Obamacare’s B-Team by getting them to vote for this perpetual extension of the current theory governing Medicare payments, which Obamacare made worse by centralizing decisions about “quality” and “value” in the federal government.

The Administration and Obamacare’s allies had hoped to get a sleepy Senate to rush this bill through on March 26, right after the Senators had pulled an all-nighter on the budget resolution. Fortunately, enough Senators had concerns about the bill’s budget busting-spending that they delayed a potentially catastrophic vote. It would have sent the president a bill that he is eager to sign, and lock in the Obamacare vision of Medicare for the foreseeable future.

Nevertheless, the Senate will have to act pretty quickly on April 13. There are much better policy options than those embraced in the current bill.

Critics Pile On Flawed Medicare Doc Fix

The Boehner-Pelosi so-called Medicare “doc fix” is taking on water, despite (or because of?) overwhelming bipartisan support in the House of Representatives.

Here’s David Hogberg at The Federalist:

……it replaces it with a new payments system that will cause the sickest Medicare patients to suffer the most. The bill’s new payment system is based on three Medicare programs: the “Physician Quality Reporting Program,” the “Value-Based Modifier,” and “Meaningful Use of Electronic Health Records,” all of which are supposed to improve the quality of treatment for Medicare beneficiaries. None of these programs have demonstrated any quality improvements on their own, yet the MACR now seeks to lump them all into one program called the “Merit-Based Incentive Payment System” (MIPS).

Honor Roll: 37 Voted Against the Budget Busting Medicare Doc Fix

“While I support an SGR replacement, I cannot vote in favor of a bill that costs more than $200 billion, while Congress only pays for $70 billion, leaving more than $130 billion to our children and grandchildren. We cannot continue to solve every problem by adding to the deficit,” Rep. Jim Bridenstine (R-Okla.) said in a statement.

The 37 Congressmen who voted against include high-ranking Republicans Darrell Issa and Jim Jordan.

Cristina Marcos of The Hill reports the entire list.

How Conservatives Rationalize the Budget Busting Medicare Doc Fix

Opposition to the outrageous so-called Medicare doc fix bill, which will increase the deficit by $141 billion, is growing. Michael Cannon of the Cato Institute explains how this will “bust the budget.” My Forbes editor, Avik Roy, pleads that the Senate stop this monstrosity (which passed the House by a huge majority). On the other hand, there are those unfortunate conservatives who endorsed the bill before the Congressional Budget Office (CBO) had announced what a budget buster it was. My friend Ryan Ellis of Americans for Tax Reform appreciates that the CBO score could give us a feeling of “whiplash”.