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Potential SGR Repeal Insurrection Brews in Senate

Critics of ‘doc fix’ initiative attack cost, amendments

After a permanent repeal of the sustainable growth rate (SGR) formula passed the House of Representatives in late March, the measure’s backers in the Senate are working to quell a potential revolt from Senate conservatives over its initial $214 billion price tag, according to Reuters.

As approved by the House, the initiative would replace a 1990s formula that linked Medicare doctors’ reimbursements to economic growth with a new one more focused on quality of care. Republican Speaker John Boehner and Democratic Leader Nancy Pelosi leaned across the aisle to get it passed overwhelmingly in the House on March 26, just before a spring break.

Some Senate Republicans, however, want the measure paid in full before they pass it, noting that the Congressional Budget Office projects that it will add $141 billion to the national debt over the next 10 years. This faction also points to an analysis by the Committee for a Responsible Federal Budget, which has cautioned against a permanent fix, indicating it would add a half trillion dollars to the deficit in the next 20 years.

Echoing these sentiments, a report from the National Center for Policy Analysis criticized the cost and scope of the bill, arguing the price tag indicated that Congress has “abandoned budget neutrality, a commitment made previously by both parties.” The report laid out alternate possibilities for a “doc fix,” including a 2-year SGR patch and finding “offsets” for the eventual $141 billion price tag.

Along the same lines, the conservative group Heritage Action for America, which opposes the bill, is urging senators to strike an exemption from congressional “pay as you go” rules that was written into the House-passed legislation. Striking the exemption would require Congress to enact enough savings to cover the bill’s cost by the end of 2015.

Senate Democrats, on the other hand, are seeking to amend the bill to double the 2 years of funding included for a children’s health insurance program (CHIP), the Wall Street Journal reported.

“There are a number of senators who want to be heard on this issue, and there ought to be an opportunity for them to weigh in,” Sen. Ron Wyden (D-Ore.), who plans to vote for the initiative, said last week, according to the Journal.

Despite the successful passage of the bill in the House, health care experts say the measure doesn’t provide enough specifics. For example, the legislation does not establish which care-quality metrics Medicare will use in lieu of the SGR.

The deadline for repeal of the SGR is April 15.

Sources: FierceHealthcare; April 13, 2015; and Reuters; April 10, 2015.

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