November 20, 2014
Area(s) of Interest: Advocacy
California Medical Association (CMA) physician leaders, along with representatives from a number of other state medical associations are on Capitol Hill in Washington, D.C., this week, to remind Congress about priority physician issues, such as final passage of H.R. 4015/S. 2000 the bill to repeal and replace the Medicare sustainable growth rate (SGR) and extending the Affordable Care Act (ACA) Medicaid (Medi-Cal) primary care rate increase set to expire at the end of the year.
Congress has scheduled a very short lame duck session before the newly elected lawmakers take office in January, during which leadership on both sides hopes to come to an agreement on a spending bill to keep the government running, among other issues.
Earlier this year, both houses of Congress were very close to a permanent repeal of the badly broken SGR formula. For the first time in a decade, House and Senate Committees had adopted a bipartisan, bicameral payment system to replace the SGR. Unfortunately, they were unable to agree on how to pay for it, even though the cost to do so was dramatically lower than in previous years.
Unable to come to an agreement on how to fund the repeal, Congress passed a patch to stop the SGR-triggered payment cuts for the 17th time in 10 years. The patch is due to expire on April 1, 2015.
CMA is urging Congress to act during the lame duck session and build on the historic progress that has already been made. The time to act is now. If this issue is carried over into the next year, Congress could lose the momentum and physicians could face the 18th patch in a decade.
This week the Congressional Budget Office (CBO) issued a new score on the SGR showing that the cost to repeal it has increased again up to $144 billion. There is also growing chorus of conservative thinkers, such as the Wall Street Journal, the Americans for Tax Reform and the Galen Institute who have all told Congress that the projected SGR cuts are phony—lawmakers having implemented short term patches year after year to stop them—and therefore, the repeal itself does not need to be offset with corresponding funding.
Luther Cobb, M.D., CMA President, told Congress that half of California physicians are over the age of 55 and nearing retirement. Passage of the Medicare payment reforms would bring stability and resources to physicians to keep them in practice. He also said that requiring financial offsets for the SGR is akin to a “pay-day loan.” It’s a waste of federal resources. On behalf of CMA, he urged Congress to move quickly to protect California seniors and military families.
The CMA delegation will also be pushing California legislators to improve access to care for Medi-Cal patients by supporting and passing S. 2694/ H.R, 5643, which will extend the ACA Medicaid payment increase for an additional two years for primary care physicians, OB/GYNs who provide primary care services, internists, pediatricians and related internal medicine and pediatric subspecialties. Under the ACA, Medicaid primary care physician reimbursement rates were increased to Medicare levels for the past two years.
The goal of the increase was to recruit more physicians to treat low-income patients who are newly eligible for health coverage under the ACA. CMA believes that it is critical that the increase be extended to ensure the 8.5 million Medi-Cal patients in California are able to find a physician to care for them. California's abysmally low Medi-Cal rates have already forced many of California’s providers to stop seeing Medi-Cal patients.