Medicare agency: House bill not quite a ‘doc fix’

The federal agency overseeing Medicare is warning that the House’s recently passed bill on the “doc fix” will not be the final step to resolving a nearly 20-year-old problem.

The chief actuary for the Centers for Medicare and Medicaid Services (CMS) wrote in a report Friday that the legislation would effectively end the two-decades-old battle in Congress over annual cuts to the Medicare physician payments. But it also said Congress would need to pass more legislation to ensure that Medicare doctors do not lose out in the long-term.

“If not addressed by subsequent legislation, we expect that access to, and quality of, physicians’ services would deteriorate over time for beneficiaries,” Paul Spitalnic, the actuary for CMS, wrote in a report.

Spitalnic wrote that the new payment rates “would be adequate for many years,” but he was particularly concerned in years with high inflation. He also raised alarms that the funding package would expire in 2025 — forcing Congress to again confront the problem of provider payments.

The Heritage Foundation, which opposes the House bill, seized on the actuary report’s findings to argue that “in fact, the House measure is not a permanent fix to the broken Sustainable Growth Rate.”

“It is much more likely that the House doc fix will be a shorter term patch requiring another series of patchwork legislation just nine years from now,” Paul Winfree, the director of the Heritage Foundation’s economic policy center, wrote in a blog Friday.

Echoing other conservative budget hawks, Winfree urged Congress to find ways to pay for the entirety of the bill.

The legislation, which was resoundingly approved by the House two weeks ago, will now head to the Senate for consideration. Lawmakers must pass a bill addressing the doctors’ payment cuts before April 15 or providers will face double-digit cuts.

President Obama has already approved of the deal, which was negotiated between Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.). Obama also said he would support an effort to include amendments in the Senate version, which senators of both parties have called for.

The actuary report confirmed that the legislation would have a net cost of $102.8 billion. The figure is close to the previously reported figure from the Congressional Budget Office, which estimated that the deal would add $141 billion to the deficit over 10 years.

The bill currently includes about $47.7 billion in offsets, which partially comes from premium increases for wealthier beneficiaries.

Just over 10 million people in Medicare Part B and Part D would be affected by higher premiums by 2015, the actuary’s report said.

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