In a rare display of bipartisan lawmaking, Congress just overwhelmingly approved a $214 billion bill that will reform the way the Medicare program pays its doctors — sending a major bill to President Obama’s desk that he is expected to sign.
The passage of the bill is being hailed as a “historic move” and the perhaps the “biggest legislative accomplishment of the year” for the 114th Congress, which has so far been crippled by political gridlock even when faced with legislation that isn’t typically controversial. When it comes to health care specifically, the bitter divide over President Obama’s signature health reform law has stalled progress on Capitol Hill for years.
So lawmakers are celebrating the fact that they came together to get something done this week. “I would say to the American people, don’t look now but we are actually governing,” Rep. Renee Ellmers (R-NC) told the Huffington Post.
President Obama has also congratulated both chambers of Congress on approving the legislation by 392–37 and 92–8, respectively, saying in a statement that he will be “proud to sign it into law.”
The package of Medicare reforms, which has come to be known as the “doc fix” bill, is a widely-endorsed solution to a complicated issue that’s plagued Congress for the past 15 years. The new legislation finally puts an end to a decade of negotiating to repeal the program’s current payment structure.
In 1997, as part of an effort to balance the budget, Congress developed the “Sustainable Growth Rate” (SGR) formula for paying Medicare doctors. Essentially, the SGR aimed to keep doctor payments in check by tying them to economic growth; but, as health costs grew more rapidly than economic growth, it quickly became difficult to implement. The cap imposed by the SGR formula threatened to slash payments significantly, and physicians claimed that such steep cuts would force them to stop treating Medicare patients altogether.
So Congress settled into an uneasy pattern: Getting precariously close to the deadline for the SGR cuts to take effect, then scrambling to pass a short-term bill to avert them at the last minute. Until this point, they had fought over SGR repeal and ultimately passed a short-term patch 17 separate times, and politicians on both sides of the aisle were growing increasingly frustrated.
Now that Congress has approved a permanent fix, lawmakers will no longer have to do that dance every single year. Under the new policy, Medicare doctors will get a modest pay increase, and then their payments will be linked to measures of quality rather than to economic growth. It’s part of a larger shift in the health care industry to reward physicians and hospitals for the quality of health care that they provide, rather than the sheer number of patients they treat and procedures they perform.
The new legislation isn’t perfect. According to the Congressional Budget Office (CBO), repealing the old SGR formula and forgoing the caps on Medicare doctors’ pay will add an estimated $141 billion to the U.S. debt over the next decade, which has been a sticking point for some Republicans. And there are some questions about how value-based payments will work in practice, because Congress hasn’t yet ironed out the specifics.
But health workers are celebrating the end of short-term fixes, saying that it will bring “stability” to the professionals working in long-term care. Sen. Ron Wyden (D-OR), the senior Democrat serving on the Finance Committee, said the new bill will finally allow lawmakers to “stop patching this leaky boat.”
Not everybody supported the doc fix. Presidential hopefuls Sens. Ted Cruz (R-TX) and Marco Rubio (R-FL) voted against the bill on Tuesday night. Cruz, who once spent more than 21 hours filibustering funding for the Affordable Care Act, says the legislation “institutionalizes and expands ObamaCare policies.”