House Passes SGR Repeal Bill – Now What?

By Christine Kern, contributing writer

Future of SGR Repeal Bill dim in Senate as Bipartisan support dissolves

NPR reports Bipartisan support dissolved last week for compromise legislation that would have fixed a longstanding problem with the way Medicare pays physicians. Though the bill passed the House of Representatives Friday, it now contains a provision almost certain to invite veto unless a Senate version can quickly nudge the ultimate bill back toward compromise.

Republican leaders in the House finally brought to a vote this week the legislation they'd unveiled in February. It was the product of several years of collaborative work by the Republican and Democratic leaders of the key congressional committees that oversee the Medicare program. The leaders, from both houses of Congress, also got input and buy-in from physician groups, and from groups representing Medicare patients.

The bill is meant to permanently fix a problem with the payment formula. Currently, that formula calls for deep cuts in Medicare payments to doctors, and has required regular “patches” by Congress over the years to circumvent those cuts.

The HR 4015, the SGR Repeal and Medicare Provider Payment Modernization Act, passed 238-181 and picked up support from 12 Democrats. Though cheered by House Republicans, the legislation is viewed by Democrats, policy analysts and healthcare providers as purely a political move that is not likely to go anywhere beyond the House floor.

The bill HR 4015, would repeal the Medicare sustainable growth rate (SGR) and put in place a replacement payment system with an amendment offered by House Republican leaders that would pay for the repeal through a five-year delay of the Affordable Care act's individual mandate penalty.

Senate Leader Harry Reid filed a motion to consider the Senate’s identical version of the Medicare legislation, S. 2000 after they return from recess. Like the House bill, the Senate legislation does not include a bipartisan way to pay for the legislation.

The House and Senate are on recess will not be returning to Washington, D.C. until Monday, March 24, which gives lawmakers one week until the temporary SGR patch expires on March 31.

ModernHealthcare reported that an amendment added by House Ways and Means Committee Chairman Dave Camp (R-MI), states that the Patient Protection and Affordable Care Act's individual mandate would remain in place but penalties for violation would not be enforced until 2019. The nonpartisan Congressional Budget Office estimated this week that this move would increase the number of uninsured Americans by about 13 million in 2018.

Senate Finance Committee Chairman Ron Wyden, who introduced a version of the SGR repeal this week, said he is committed to sound, sensible policy over politics. The bill that Wyden introduced this week—the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014—includes the compromise agreement from the Senate Finance, House Ways and Means and House Energy and Commerce committees to repeal and replace the SGR, as well as the extension of certain Medicare programs that are expiring.

It does not, however, include a way to pay for these provisions. Meanwhile, the House bill that passed on Friday includes the compromise agreement on SGR, no language on the Medicare extenders and the dead-on-arrival delay in the ACA's individual mandate to pay for it.