The Senate has passed a six-month payment increase for Medicare physicians but it is unclear if the House will pass that measure. Meanwhile, the Senate continues to debate a larger legislative package that would provide additional Medicaid funding for states. That bill may be amended to provide additional COBRA funding for workers who have lost their jobs and their health insurance.
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. The so called “doc fix” is still in play on Capitol Hill. The Senate on Friday passed a Bill to protect fees paid to doctors who are seeing Medicare patients. The House is expected to take up that measure this week.
Here to bring us up to date on that issue as well as others are Mary Agnes Carey, senior correspondent for Kaiser Health News, and Julie Rovner of National Public Radio. Welcome to you both.
Julie, it wasn’t easy for the Senate to get to the finish line on the doc fix. How did they get there?
JULIE ROVNER: Well, of course they are several weeks late on this last delay of this 21-percent cut for doctors. It actually ran out June 1st. Medicare has been holding these payments in hopes that Congress would actually go ahead and pass another stop gap measure to cancel this cut and actually that ran out on Friday, and now Medicare is processing the bills that it has been holding with the 21-percent cut, starting today.
The Senate had the cancellation of the cut as part of a broader measure of tax cut extenders and some other spending packages including unemployment compensation. They couldn’t get that bill through so finally on Friday, they just split out the doc fee fix as it were and passed that.
It is a standalone bill, six months, 2.2-percent increase, they got some offsets, passed it by unanimous consent, so the Senate wasn’t even there to vote on it, and sent it over to the House, but boy, it has really been quite a struggle because now the Republicans and several Democrats have decided that this must be paid for. No longer can this be considered emergency legislation.
Now, I should point out when the Republicans cancelled these cuts and the reason it is a 21-percent cut is that it has been building up over time. Every time the Republicans cancelled the cuts from 2003 to 2006, they just put them off, which is what made them so big.
It used to be a 4-percent cut, and then a 5-percent cut, and in 2006, the last time Republicans were in charge and they cancelled the cut, they basically said let’s just put it off. Let’s not have it. But, that is what has made it so large is that the Republicans, when they were in charge, just kept loading it on to future years, and now it is 21-percent.
JACKIE JUDD: And what the Senate finally did is different than the bill that the House passed earlier, so the Senate measure now is in the House, and Nancy Pelosi, the House Speaker, is talking about maybe not taking a vote on it.
MARY AGNES CAREY: News reports over the weekend, she described the bill as inadequate, saying she sees no need to pass this until they see what sort of jobs legislation comes out of the Senate. This was what Julie was talking about.
The bigger bill on the tax extenders, the unemployment compensation, the Speaker seems to be indicating she wants to see where the Senate will move on that before she moves on their six month position payment fix.
As you noted, in the House before they went out for Memorial Day break, they had a 19 month doctor payment adjustment, money through the end of the year, about 2.2-percent, just like the Senate did, the Senate is through the end of November, and then the House package would also have had a 1-percent increase for next year, so the packages are also very different.
JACKIE JUDD: And what you both have been alluding to is COBRA, the extension of unemployment benefits for people who have lost their jobs, who would get federal subsidies. Will this come back in some form in the Senate or is it for the moment a dead issue?
MARY AGNES CAREY: It is absolutely alive in the Senate. Senators Casey and Brown, two Democrats, have put forth an amendment now, it wouldn’t be as generous of an extension as previously had been out there.
In the stimulus bill from last year, there was a 15 month extension, a 65-percent subsidy to help folks who have been laid off from their jobs pay for their health insurance under this program known as COBRA. It is quite expensive. The current pending amendment in the Senate would have that adjustment just for six months.
These are for folks that go into the program from June 1st through the end of the year, so it is scaled back with an attempt to pass it, but again this hasn’t been passed yet in the House. This is one of those points of contention that is still out there under discussion.
JULIE ROVNER: Now, remember it is important that in the House, it couldn’t get through because again you had Democrats who did not want to add to the deficit.
JACKIE JUDD: The Blue Dogs.
JULIE ROVNER: Wanted it paid for, so the House passed the bill without it, hoping that it would get added in the Senate. The Senate kept scaling the package back, but they needed 60 votes and the closest they got on a package was 56 votes Thursday night, and so they could not get their whole package through either, so both this COBRA extension and money for the states for Medicaid are sort of hanging out there, waiting to see, and it is not just the COBRA, it is actual unemployment benefits, too.
It’s the money that people get for their regular unemployment benefits. There is an awful lot in this bigger bill that is hanging out there, waiting to see what Congress can get approved.
JACKIE JUDD: Right and as you just mentioned, Medicaid funding for states, a significant issue for many states which have already factored in those dollars into their annual budgets, what do these states do in the meantime while they wait for Congress to act and they hope approve the additional funding?
MARY AGNES CAREY: Well you could certainly see some variety of changes. You could see changes in how the Medicaid providers, the doctors, the hospitals, nursing home care is a big piece of Medicaid, those reimbursements could be reduced. This is mandatory funding the states have to come up with, so that may mean they borrow it from other parts of the budget.
It could mean a reduction in spending on teachers, or spending on police, or a variety of other functions because again they have to come up with that Medicaid funding as they wait to see if Congress provides relief.
JULIE ROVNER: A lot of states are in a bind because state legislatures have already met and adjourned for the year. Remember we are now to the end of June; a lot of states meet early and are gone by April and May. They assumed they were going to get this money, so they built it into their budgets.
Now if they are not going to get this money, the legislatures are gone, so it is very difficult to make changes. Governors may have to call back the legislatures to have special sessions to make cuts elsewhere in the budget because these budgets have basically been finalized, assuming that that money was going to come in.
JACKIE JUDD: Is what we have seen over the past three or four weeks with these tangles in Congress something we are going to continue to see through the midterm elections in November?
MARY AGNES CAREY: I think so.
JULIE ROVNER: House Majority Leader Steny Hoyer last week referred to something called spending fatigue. I think last year when they did the stimulus bill, I think there was a hope that that would have more of an immediate impact on the economy.
The fact that it hasn’t, Republicans have really been beating up on it, back to sort of seeing Democrats as big spenders and the Republicans are really hammering on this issue of the deficit and the debt. So now we have got a lot of Democrats who are worried that they are being seen as over spending.
So the Republicans won’t vote for anything that adds to the deficit or to the debt, and so even things that are seen as necessary spending to stimulate the economy to do things that states need, that Medicare physicians need, things that sort of everybody agrees on as a policy, you have to find ways to pay for.
That is difficult because obviously it is painful to find things to cut in this economy and so you end up in these enormous tangles, and I think that is what has happened here. There has not even been a budget this year yet. It is already the end of June. Democrats are saying they probably won’t do one. It is going to be very hard to get anything through between now and the end of the year.
JACKIE JUDD: Well, it will be an interesting summer to watch. Thank you both very much, Julie Rovner, Mary Agnes Carey. And thank you. I’m Jackie Judd and this has been Health on the Hill.