Blown 'doc fix' deadline leaves Medicare payments in limbo

Congress was one vote away from ending its perennial Medicare “doc fix” dilemma for good, after nearly two decades of last-minute deals to prevent a healthcare meltdown.

But instead of capping a rare week of productivity on Capitol Hill with the approval of a bipartisan fix ahead of a crucial Tuesday deadline, the Senate punted on the legislation in the wee hours of Friday morning.

Inaction on the measure has left Medicare reimbursement checks to doctors around the country in limbo, and both parties pointing fingers at one another.

The $200 billion bill had sailed through the House on a huge bipartisan vote Thursday, and it appeared to many in Congress that the Senate would pass bill before leaving town for a two-week recess.

Instead, a small core of opposition forced Senate leaders to hold off on the vote until at least April 13.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellHill.TV poll: Majority of Republicans say Trump best represents the values of the GOP The Hill's 12:30 Report Republican strategist: Trump is 'driven by ego' MORE (R-Ky.) has predicted a big “yes” vote for the measure, but said he couldn’t advance the bill with some senators still opposed. It’s unclear how many would have blocked the bill.

His spokesman, Don Stewart, said Monday that he didn’t have “a list like that."

“There wasn’t unanimous consent,” said Stewart, adding that McConnell believed opposition was “limited.”

Senate Minority Leader Harry ReidHarry Mason ReidBattle of the billionaires drives Nevada contest Senate Democrats should stop playing politics on Kavanaugh Celebrities dive into midterms, hoping to thwart Trump MORE insisted that his caucus was ready and willing to consider the bill. He hinted that McConnell was to blame for failing to bring up the legislation.

"We do know for certain that there was at least one objection on the Republican side and none on the Democratic side," a Senate Democratic leadership aide said Monday. "Our side told their side we were ready to hold a vote Thursday night and Republicans said they couldn't clear the agreement on their side because there was an objection."

Senators including Ron WydenRonald (Ron) Lee WydenGroup files lawsuit to force Georgia to adopt paper ballots Treasury releases proposed rules on major part of Trump tax law Rubio slams Google over plans to unveil censored Chinese search engine MORE (D-Ore.), Richard Blumenthal (D-Conn.), Chris MurphyChristopher (Chris) Scott MurphyFormer Teacher of the Year wins Connecticut primary Live results: Wisconsin, Minnesota, Vermont, Connecticut hold primaries The Hill's Morning Report — Signs of trouble for Republicans in House special election MORE (D-Conn.) and Ben Sasse (R-Neb.) all criticized the SGR package after it was first introduced this month, though not one explicitly said they would have blocked the vote from consideration on Friday.

After the lopsided 392-37 House vote, supporters from both parties urged the Senate to take up the legislation before leaving for its two-week break.  

“It’s time to send it over to the world’s greatest deliberative body — and let them deliberate for only a short period of time,” Rep. Michael BurgessMichael Clifton BurgessOvernight Health Care: Trump officials move to expand non-ObamaCare plans | GOP fails to block DC individual mandate | Ebola returns to Congo Republican chairman wants FTC to review mergers of drug price negotiators Overnight Health Care: Official defends suspending insurer payments | What Kavanaugh's nomination means for ObamaCare | Panel approves bill to halt employer mandate MORE (R-Texas) said on the House floor on its final day in session.

Some said they were mystified that the Senate did not act on the measure before leaving town.

“We were really baffled,” a House GOP aide said Monday.

As a result, Congress will officially miss the “doc fix” deadline on Tuesday. The Senate’s inaction puts Medicare doctors in the lurch as they brace for the double-digit cuts to their reimbursement rates that go into effect April 1.

The federal government has ways to halt the cuts — but only if it trusts that the Senate will deliver on its promise to pass the bill swiftly after its two-week recess.

The Centers for Medicare and Medicare Services (CMS) told providers last week that it is already preparing to make the 21 percent cuts if Congress does not act. But officials also sought to calm tensions by pointing out they can hold checks for 14 calendar days under current law to temporarily protect doctors from the cutbacks.

Champions of the SGR bill, including House Ways and Means Committee Chairman Paul RyanPaul Davis RyanDems make history, and other takeaways from Tuesday's primaries Ironworker and star of viral video wins Dem primary for Speaker Ryan's seat Live results: Wisconsin, Minnesota, Vermont, Connecticut hold primaries MORE (R-Wis.), have also floated the two-week option as a way to avert fallout from the cuts.

“There’s about a two week transmission delay before a cut is felt by doctors,” Ryan told reporters Thursday after the House vote.

That option was used in 2002 and 2010 when Congress also failed to meet its “doc fix” deadline.

Still, that two-week grace period only gives the federal government until April 11 to decide its next steps — at least two days before the Senate will take up the bill. CMS told providers that it would update them with the current “status of Congressional action” on or before that date.

Even with the deadline looming, the exact timing of the Senate’s vote remains in flux. McConnell has pledged to repeal the "doc fix" immediately upon returning, although Stewart said Monday that it was unclear when exactly that vote could happen.

A former CMS administrator said last week that the federal government could hold the checks until Congress passes a bill, even if it’s beyond the two weeks.

"You could hold it off for 3 months if you wanted to,” said Tom Scully, who led CMS under President George W. Bush. He added that providers will only go along with the delays if it’s nearly certain that Congress will repay them later.

“But after two weeks, it gets pretty awkward,” he said.

Federal health officials could also begin paying doctors at the reduced rate temporarily, and then plan to reimburse the money after Congress passes a bill. But the extra time to double-process the payment claims would be costly and a “waste of time,” Scully warned.

Several doctors groups that had supported the SGR bill immediately voiced frustration with the Senate’s inaction.

Two of the biggest — the American Medical Association and the American Academy of Family Physicians — both urged the Senate to make the bill its first priority after the recess.

“The time to act is now. The House has provided an overwhelming bipartisan vote of approval. The Senate should do no less and should do so as quickly as possible,” the family doctor’s group wrote in a statement. “Americans have already waited 12 years for this vote."