Senate set to vote on SGR bill amendments as CMS warns proposal is not enough

The Senate is expected today to take up several amendments to a bill that includes a provision to permanently repeal the Sustainable Growth Rate (SGR), a measure passed late last month by the House. However, a new report from the Centers for Medicare & Medicaid Services adds to the chorus of reservations in recent weeks about the agreement hailed as a rare bipartisan solution.

Leaders in the Senate will likely enforce limited debate on the amendments to the Medicare Access and CHIP Reauthorization Act of 2015, which means the legislation needs 60 votes to pass, according to The Hill. Minority Leader Harry Reid (D-Nev.) said Senate leaders want to restrict the process to "three simple amendments," which sources told The Hill will likely involve repealing Medicare's therapy cap and removing language potentially restricting abortion access and doubling the bill's two-year extension of the Children's Health Insurance Program.

Among the provisions contained in the bill is legislation to replace the SGR formula, which is used to calculate Medicare payments to physicians. Since its implementation in 1995, Congress has deployed it only once and instead has authorized 17 short-term annual fixes to prevent the payment cuts.

The current patch expired March 31, but because it takes a minimum of 14 days to pay claims from doctors, the government can continue to make payment to doctors without imposing the pay cuts if the Sentate votes to approve the measure by Wednesday. 

Senate Republicans, who have expressed concerns over the $214 billion cost of the fix, will likely add at least one amendment as well. Sen. Mike Lee (R-Utah), one of the leaders of this faction, has pushed for an amendment requiring Congress to cover the cost under standard "pay as you go" protocols, according to The Hill. "With the Wednesday deadline bearing down on us, it's too late to give taxpayers their rightful place at the table. My amendment will at least make sure we don't stick them with the bill," Lee wrote Sunday in an opinion piece for the Deseret News.

CMS Chief Actuary Paul Spitalnic, meanwhile, has issued a report that casts doubt on the bill's value as a long-term solution to physician reimbursement problems, and that Congress will likely have to pass further legislative fixes in the future. The funding, Spitalnic notes, expires in 2025, and inflation would likely make the bill's new payment rates insufficient.

"If not addressed by subsequent legislation, we expect that access to, and quality of, physicians' services would deteriorate over time for [Medicare] beneficiaries," Spitalnic wrote.

One Senator said Tuesday he plans to vote against the doc fix. Sen. Ted Cruz (R-Texas), the newly declared presidential candidate, said in a statement that he opposes the legislation because it expands healthcare reform policies and adds billions to the federal deficit. 

To learn more:
- here's the Hill article
- read Lee's opinion piece
- check out the CMS report
- here is the Cruz statement