March 28, 2013
Area(s) of Interest: Access to Care Advocacy Health Care Reform
Last weekend the U.S. Senate passed its first budget in four years by a largely partisan vote of 50 to 49. Four Democrats voted against it and no Republicans voted for it. Although it is unlikely a budget that emerges from the Republican-controlled House of Representatives will look anything like the Senate's, there were several bipartisan health care amendments that could foreshadow future compromises.
Perhaps the most interesting amendment is one introduced by Sen. Patty Murray (D-WA), chair of the Senate Budget Committee that would repeal the Medicare sustainable growth rate (SGR) formula and stop the 2 percent sequestration cut to Medicare reimbursement.
The Murray-sponsored resolution factors in the $138 billion cost of maintaining Medicare rates at their current level for 10 years. The plan features a deficit-neutral reserve fund for replacing SGR with another payment arrangement. It also stipulates a savings of $275 billion over 10 years that could offset the cost of both SGR and the sequestration cuts to Medicare. The Murray resolution allocates almost $1 trillion to replace the sequester cuts.
Other resolutions included one that would repeal the entire Affordable Care Act (ACA). This action was blocked by Senate democrats, but three smaller bipartisan measures that would repeal pieces of the ACA did make their way into the Senate budget. These include: an overhaul of the Medicare wage index, which would cut payments to California hospitals; a provision to repeal a cap on flexible spending accounts (FSA), which would also kill the ACA requirement that patients have prescriptions to buy over-the-counter drugs with FSA funds; and a repeal of the 2.3 percent medical device tax.
The Senate Budget Committee also adopted an amendment that would require the Congressional Budget Office (CBO) to file a report annually on the budgetary effects of Americans losing employer-sponsored insurance and buying insurance through public exchanges. The report would analyze the effects if 30 percent, 50 percent and 100 percent of Americans moving their coverage to exchanges. The CBO is also required to report any changes in direct spending and revenue associated with the ACA including the net effect on the deficit.
The Senate budget now goes to the House, where it is expected to be killed. The Senate recently voted down a budget proposal passed by the Republican-controlled house.
The two budget proposals and a third one to be offered by the president will likely be used as a basis for future negotiations between the parties.