S 1776 Rejected

[Prof Moriarty]

S 1776: "A bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula..."

Motion for cloture rejected today. Vote was predominantly along party lines... Dem's for, Repub's against. Actually, I don't think a single republican voted for it. It would have moved the bill forward to consideration in the Senate.

http://www.senate.gov/legislative/L...ote_cfm.cfm?congress=111&session=1&vote=00325

Am I missing something here? Thoughts?

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[Prof Moriarty]

Some answers...

http://senatus.wordpress.com/2009/1...al-motion-on-medicare-physician-fairness-act/

http://www.californiahealthline.org...re-PhysicianPay-Formula-Stalls-in-Senate.aspx

From the ACP'st Blog:
http://blogs.acponline.org/advocacy/2009/10/congress-again-fails-to-end-sgr-lunacy.html

Just a few days ago, it looked like Congress might actually do the right thing and end the annual cycle of enacting short-term measures to stop Medicare payment cuts caused by the Sustainable Growth Rate (SGR) formula, only making the problem harder and more expensive to fix the next time around.

But today by a 47-53 vote, the Senate - including 13 Democrats - voted against a motion to end a filibuster against S. 1776, the Physician Payment Fairness Act of 2009, even though the bill had the support of the White House, Senator Finance Committee Chair Max Baucus (D-MT), and Senator Chris Dodd (D-CT), acting chair of the Senate HELP committee during the (late) Senator Ted Kennedy's illness. S. 1776 would have repealed the SGR and eliminated all of the accumulated cuts caused by the formula.

S. 1776 failed despite a huge grass roots push by the ACP, American Medical Association, and other physician organizations, and despite the fact that AARP, the voice of America's seniors, supported the bill.

The bill was victim to the dysfunctional political environment today that makes consensus so difficult. Many Republicans viewed the bill largely as a Democratic effort to "buy" physicians support for health care reform (a cynical and unsupported allegation - more on this later) and they wanted to deny the Democrats a victory on anything having to do with health care reform. They also wanted the cost of the SGR repeal to be counted against the cost of the health reform bill, so that the bill would be seen as blowing a hole in the deficit. (Never mind that the SGR, which has led to all of the accumulated cuts and costs we are now facing today, was created by the Congress in 1997, when the GOP was in control, and that past Congresses, Republican and Democratic alike, have failed to take the steps needed to fix it. The SGR problem and its cost would be with us today, even if there was no health reform bill.)

It also seems many Democrats have had the equivalent of a death-bed conversion to fiscal responsibility, or at least a make-believe version of fiscal responsibility that says that pretending to save taxpayer's money is the same as saving them money. The Senators know that the $245 billion price tag for SGR repeal is itself a budget fiction, because it requires that we suspend disbelief and assume that Congress will actually allow double-digit cuts in physician payments to go into effect. They won't and they know it. Medicare will end up spending the $245 billion anyway, but that doesn't matter, as long as the Senators can tell voters that they didn't vote for a bill that would add to the deficit.

ACP has released a statement that is harshly critical of the Senate vote and vowing to continue to push for SGR repeal. The statement takes on the charge that S. 1776 was offered in exchange for physician support of health reform:

"The American College of Physicians rejects the cynical charge made by some that physicians' support for health care reform is conditioned on repeal of the SGR. Instead, ACP supports health care reform because we believe that all Americans should have access to affordable care. Our positions on the pending health reform proposals will continue to be based on how they align with ACP's long-standing policies on ensuring coverage, reversing a catastrophic shortage of primary care physicians, and testing and implementing new models of payment and delivery to align positive incentives with the value of care provided. At the same time, we believe that repeal of the SGR is necessary to provide the stability needed to achieve real and lasting physician payment reform, to implement payment reforms to support the value of care provided by primary care physicians, and to assure seniors' access to care."

Where does this leave us on the SGR? Right where we were in . . . 2008, 2007, 2006, 2005, 2004, 2003, 2002, and 2001 . . . with Congress saying that they know the SGR has to go, that they won't allow the cuts to go into effect, that they know that have to find a permanent solution, but not now, some other time. Like the Chicago Cubs and a World Series appearance, it seems it is always "wait til next year" when it comes to repeal of the SGR.

 

[AmericanMD]

Longtime reader of this forum, this is my first time posting in it.

I'm a first year med student, and I've been following the health care debate closely. I'm worried I won't be able to pay off my loans if Obama gets his way. That said, I also believe that America has got to get it's finances in shape soon or face disaster. This bill, though it would temporarily help doctors, just spends another $250 billion we don't have. Here's my question: wouldn't this just speed the bankruptcy of Medicare if this would've been enacted? What then? This situation just sucks no matter which way you slice it. Keep payment rates the same and spend money we don't have, or slash rates and eliminate access to care for all the seniors, which ironically was what Medicare was created for in the first place. Ugh. I'd appreciate hearing all of your opinions on this bill; you guys obviously know more than I do since I'm just an M1.

 

[Prof Moriarty]

From what I can gather, the $250 billion price tag is a false cost, in the sense that every year congress does some last minute, hang-by-the-seat-of-your-pants, temporary fix. It's not like they actually let the flawed formula knock 20% off of medicare payments every year. So they just keep putting a band-aid on it. They're gonna spend this money whether they officially fix this thing once and for all or not. And by taking the approach of temporarily fixing it year by year, they waste valuable time, energy, and yes... more money.

 

[Prof Moriarty]

[FONT=Arial, Helvetica, sans-serif]Not that the current rates are favorable to anesthesiology, but 20% less would still be worse...

Yesterday's Senate Vote on S. 1776
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[FONT=Arial, Helvetica, sans-serif]To: AMA Members.
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[FONT=Arial, Helvetica, sans-serif]An overwhelming majority of U.S. senators, Democrats and Republicans alike, are on record stating that the so-called Medicare sustainable growth rate (SGR) is flawed and should be replaced. S. 1776, the Medicare Physician Fair Payment Act, introduced last week by Sen. Debbie Stabenow, D-Mich., would have repealed the SGR, erasing the existing debt and freezing physician payments at current rates for 10 years. Yesterday's Senate vote (PDF) on S. 1776 was an opportunity for every senator to deliver on their pledge of support for repealing the SGR. Instead the Senate voted 53-47 to block consideration of S. 1776.
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[FONT=Arial, Helvetica, sans-serif]The blame game being spun by some politicians over the outcome of that vote should be seen for what it is—pure political gamesmanship.

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[FONT=Arial, Helvetica, sans-serif]Notwithstanding all of the hard work conducted by physicians who reached out to senators of both parties, this bill was blocked for these basic reasons: .​

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   There is growing concern on the part of legislators and the public over expanding federal deficits. Therefore, a number of moderate Democrats and Republicans, although concerned about the SGR problem, simply would not vote for a bill they viewed as having negative deficit implications.​
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2. [FONT=Arial, Helvetica, sans-serif]The Senate Republican leadership cast this as a test vote on Democrats' health reform legislation. .​

[FONT=Arial, Helvetica, sans-serif]The problem is that another temporary fix of the SGR formula will merely exacerbate the very deficit problem that so concerns many senators. .​

• [FONT=Arial, Helvetica, sans-serif]In 2005, the cost of repealing the SGR was $48 billion over ten years and physicians were facing cuts of 3.3 percent. .​
• [FONT=Arial, Helvetica, sans-serif]Today, the price tag to permanently repeal the SGR is $245 billion and next year's scheduled cut is 21.5 percent. .​

[FONT=Arial, Helvetica, sans-serif]The AMA shares concerns about federal deficits but we believe the responsible thing to do is to finally stop the Ponzi-like scheme to manage the SGR. Instead, Congress must once-and-for-all fulfill its obligation to senior citizens and the physicians who treat them. They can do this by wiping the slate clean and adopting a realistic baseline not predicated on physician payment cuts of 40 percent over the next several years.

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[FONT=Arial, Helvetica, sans-serif]This effort to permanently fix the SGR isn't over, but we should acknowledge a few positive developments associated with S.1776 including continuing strong support and leadership by Sen. Stabenow and active support from the AARP and the Military Officers Association of America. We also need to thank the 47 Democratic senators who voted for cloture.
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[FONT=Arial, Helvetica, sans-serif]We need to take a moment to clear up erroneous trade press reports over an Oct. 13 meeting with Sens. Reid, Baucus and Dodd and senior White House staff. At that meeting, the AMA did not agree to support a Senate bill still being drafted. While expressing our ongoing commitment to achieving meaningful health system reform goals this year, we reiterated clearly the AMA's continuing concerns with a number of provisions of the Senate Finance Committee's recommendations. These concerns have yet to be fully addressed.
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[FONT=Arial, Helvetica, sans-serif]Finally, a word about medical liability reform.
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[FONT=Arial, Helvetica, sans-serif]The AMA has been a strong and consistent advocate for medical liability reforms. As a direct result of AMA advocacy, President Obama has authorized a $25 million grant program for state pilot projects for alternative medical liability reforms. This concept was the subject of proposed Senate legislation over the past few years, but was never reported out of committee. The pilot projects would allow a broader array of alternatives than those contained in the amendment to H.R. 3200 adopted by the House Energy and Commerce Committee in July. Proposals to implement health courts and safe harbors would be eligible for grants that will be funded by the Agency for Healthcare Research and Quality (AHRQ) early next year.
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[FONT=Arial, Helvetica, sans-serif]The Oct. 21 edition of The Wall Street Journal acknowledged what many observers have long known when it stated "...tort reform is dead on arrival" in the U.S. Congress. Amendments for MICRA style caps on non-economic damages were defeated by large margins in the House of Representatives and in the Senate HELP Committee earlier this year. When Republicans controlled the Senate, House and the White House, MICRA style reforms were not enacted. At this time, there are less than 40 votes for MICRA style reforms.
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[FONT=Arial, Helvetica, sans-serif]So, moving forward, what can you expect from the AMA?
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[FONT=Arial, Helvetica, sans-serif]The AMA has advised Congress and the Obama Administration that we do not support another short-term fix that grows the SGR deficit.
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[FONT=Arial, Helvetica, sans-serif]We stand by our seven essential elements for health system reform. Consideration of the House and Senate health reform bills coming up for floor votes in the coming weeks will be evaluated based on the following metrics: .​

• [FONT=Arial, Helvetica, sans-serif]Does the legislation adequately address the AMA's seven essential elements of health system reform? .​
• [FONT=Arial, Helvetica, sans-serif]Does the legislation correct existing failures to fulfill current obligations to patients and physicians? .​
• [FONT=Arial, Helvetica, sans-serif]Are new obligations based on sound policy and financial foundations that are sustainable and will deliver on the promise of real access to care? .​

[FONT=Arial, Helvetica, sans-serif]In closing, we thank state, county and national specialty societies and individual medical students, residents and physicians for their outstanding response to our grassroots campaign on S. 1776. Over 42,000 contacts to Senate offices were generated in just five days. This was a tremendous demonstration of how medicine can mobilize to support a common goal.
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[FONT=Arial, Helvetica, sans-serif]Sincerely,.

[FONT=Arial, Helvetica, sans-serif]J. James Rohack, MD, President.​

[FONT=Arial, Helvetica, sans-serif]Rebecca J. Patchin, MD, Chair, Board of Trustees.​