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AMA, Doctors Pushing Congress to Fix Medicare Patch

As if Congress didn’t have enough unfinished business to deal with in its lame-duck session, doctors’ groups are stepping up their pressure on lawmakers to approve another temporary reprieve from Medicare payments cuts scheduled to go into effect next month.

The American Medical Association this week is running print ads and is coordinating a call-in from its doctors to Members on Wednesday urging Congress to prevent cuts in physician reimbursements for 13 months.

“Everyone in Congress knows that this cut will cause problems for seniors, and the AMA is working to turn that concern into action before time runs out this month,” AMA President Dr. Cecil Wilson said in a statement Monday.

Debate over proposals to deal with reductions in physician Medicare payments, known as the “doc fix,” has become increasingly contentious on Capitol Hill because of rising concerns about the federal deficit. Furthermore, many Republicans who have long been allied with the medical establishment have become less willing to support such fixes because of their anger at the AMA for endorsing the Democrats’ health care reform law.

Congress last passed a six-month patch for physician payments in June, but only after a protracted debate that resulted in doctors facing reductions in payments.

The AMA has long argued that Congress needs to permanently overhaul the Medicare formula rather than making short-term changes just before a cut is scheduled to take effect. But in light of the short work period of the lame-duck session, the medical association has proposed rolling back the cuts for just over a year and then allowing the new Congress to consider more permanent solutions.

If Congress does not act by the end of the month, doctors face a 23 percent cut in Medicare reimbursement rates at the beginning of December and a 25 percent cut in January.

Rep. Phil Gingrey (R-Ga.), co-chairman of the GOP Doctors Caucus, said Congress needs to address the physician payment situation by the end of this month. In an e-mail to Roll Call, he added, “as we look beyond this lame duck session of Congress, we must achieve more than short term patches and find a permanent solution to the current Medicare physician payment system.”

The AMA is not the only lobby pressing Members on the issue. Groups involved with military health care are also mobilizing their membership to sway lawmakers against the cuts because TRICARE, the defense department’s health insurance plan, ties its reimbursement rates to Medicare.

“They are hearing from us,” said Kathryn Beasley, deputy director of government relations for the Military Officers Association of America.

While Beasley said the relevant Members of Congress, including leadership, are well aware of the reimbursement issue, she was unsure whether they would deal with it now. Beasley said her hope is that lawmakers would approve a two-month fix at the very least. That temporary reprieve would then allow the new Congress to take up the issue early next year.

AARP, the senior citizens group, also sent a letter Monday to Congressional leaders, urging them to prevent the cut.

The Congressional leadership does not appear to have settled on a plan to deal with the physician reimbursement problem.

An aide to Senate Finance Chairman Max Baucus (D-Mont.) said that while the chairman supports a permanent physician payment fix, “obviously the votes are not there for that at this time.”
“He’s working to get the longest possible extension that can pass at this time,” said the aide, who added that any extension will need 60 votes to overcome a filibuster.

Health care observers said any temporary fix will likely be tacked on to larger legislation, such as a budget or tax measure, rather than go as a stand-alone bill.

The AMA is one of the top spending advocacy groups in Washington, shelling out $17 million in lobbying expenses in the first three quarters of this year.

Even though the medical association wields considerable clout, it has faced criticism from GOP lawmakers. Some Republicans have questioned why the AMA didn’t hold out its support of the health care bill until it got a deal on its doc fix.

A better reception next year is uncertain, as the new Congress will have more Members who are critical of the health care law and are opposed to passing measures that will increase the deficit. The freshman class includes doctors who have been critical of the health care law, including Sen.-elect Rand Paul (Ky.), a tea-party-backed Republican and an ophthalmologist.

The AMA may also have to do some making up with Republicans who will be running the House in the next Congress. In the most recent election cycle, AMA’s political action committee gave the maximum $10,000 in contributions to Democratic House leaders, including Speaker Nancy Pelosi (Calif.), Majority Whip James Clyburn (S.C.) and Rep. Chris Van Hollen (Md.), chairman of the Democratic Congressional Campaign Committee.

By contrast, the medical association PAC gave $5,000 to GOPers including Minority Leader John Boehner (Ohio), Minority Whip Eric Cantor (Va.) and Rep. Mike Pence (Ind.), the chairman of the House Republican Conference.

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