SGR Proposals Move Forward in the House and Senate
SGR Measure Passes in the House that Ties Repeal to a Delay in the ACA’s Individual Mandate; Senate Finance Committee Chairman Ron Wyden Introduces Legislation that would Repeal the SGR Formula without Requiring Offsets
March 19, 2014 12:07 PM
Late last week – just prior to adjourning for a weeklong recess – the House of Representatives passed a bill that repeals the sustainable growth-rate formula (SGR) and also includes a five-year delay of the financial penalties for people who don't purchase health insurance, known as the “Individual Mandate,” that was included in the Affordable Care Act (ACA). The measure – officially known as the, “SGR Repeal and Medicare Provider Payment Modernization Act,” passed the House on a vote of 238 – 181. 12 Democrats joined their Republican colleagues in voting for the measure.
Given that the House bill ties repealing the SGR to delaying yet another provision of the ACA, the measure is likely dead on arrival in the Democratic-controlled Senate. However, Senator Ron Wyden (D-OR), the chairman of the Senate Finance Committee, which has jurisdiction over Medicare, introduced his own SGR repeal bill on March 13, 2014. Chairman Wyden’s bill would repeal the broken SGR formula, though would not tie its repeal to delaying the Individual Mandate. Senator Wyden’s bill would not require offsets to pay for SGR repeal.
“If Congress fails to fully repeal the flawed Medicare payment formula now, I believe there will be cuts to other providers, hospitals, home health care providers, drug companies, skilled nursing facilities,” Senator Wyden said while introducing his bill on the Senate floor. “We'll be able to accomplish what we were sent here to do - find a way to do what's best for seniors and the doctors who care for them.”
According to Wyden’s office, his SGR repeal bill would:
Repeal the SGR and end the annual threat to seniors’ care, while instituting a 0.5 percent payment update for five years.
Improve the fee-for-service system by streamlining Medicare’s existing web of quality programs into one value-based performance program. It increases payment accuracy and encourages physicians to adopt proven practices.
Incentivize movement to alternative payment models to encourage doctors and providers to focus more on coordination and prevention to improve quality and reduce costs.
Make Medicare more transparent by giving patients more access to information and supplying doctors with data they can use to improve care.
Extend current law health care and human services policies that ensure affordable Medicare premiums for low- income seniors and guarantee beneficiaries have access to needed therapy services.
Congress returns next week and SGR negotiations are expected to begin in earnest to meet the March 31 deadline, which is when the most recent SGR patch expires. Given that these critical negotiations will be happening at the same time as NAHC’s March on Washington, all NAHC members are encouraged to join their peers and colleagues in Washington, DC to take part in this year’s March and make the case directly to lawmakers to reject any proposals to use home health and hospice payment cuts or copays to offset the cost of the SGR fix.
To learn more about the March on Washington, please click here.