Last week I wrote about the anticipated 23 percent cut in Medicare physician reimbursements. And I explained that this cut is the result of a Clinton-era formula for reimbursement — called the â€œsustainable growth rateâ€ (SGR) — not the new health care reform law. And I also wrote about the way Republicans in Congress blocked all attempts at a remedy so they could go home to their constituents and blame the looming cuts on “Obamacare.”
N.C. Aizenman writes about this in the Washington Post — “Doctors say Medicare cuts force painful decision about elderly patients.” Physicians complain that they can’t afford to see Medicare patients, they say, because since 2000 their expenses have gone up 18 percent but reimbursement has gone up only 5 percent. And then there’s that 23 percent cut, which will go into effect December 1 if Congress can’t stop it.
Aizenman also writes in the WaPo article that the way physicians are reimbursed now tends to overpay specialists and underpay primary care physicians. This has been going on since before Barack Obama was elected.
What’s not mentioned anywhere in this news story is the Patient Protection and Affordable Care Act (PPACA), or this year’s health reform law. That’s because the PPACA really isn’t part of this situation. The only connection is that a provision in an early version of the bill that would have eliminated the SGR was cut out at the insistence of deficit-hawk conservatives.
In other words, the passage of the PPACA did not cause this problem, and what parts of the PPACA that might help rein in Medicare costs eventually haven’t gone into effect yet, again to placate the deficit hawks. Yet that didn’t stop The Usual Knees from jerking.
Remember folks, all that talk about Death Panels, reduction of doctorsâ€™ availability, etc. under Obamacare was just a series of Republican lies. … So now that we passed it, and we are beginning to see what is in it, how does it look? Do you think maybe we should have figure out what was in it, before we passed it?
Amusingly, the blogger quoted above urges his readers to “read the whole thing” when he, apparently, did not. Or else he can’t read.
Recall that these steep cuts to Medicare reimbursement rates are the way in which the Obama administration was able to claim that a) Obamacare cost less than a trillion dollars and b) it would bend the cost curve. In fact, the administration now has a stark choice between instituting the â€œdoc fixâ€ which would rescind the Medicare cuts or welcoming in the era of decreased access and rationing via long wait times. They donâ€™t have long. The rate cuts to Medicare reimbursement are set to begin December 1st.
But the rate cuts were not dictated by the PPACA but by another law passed back in 1997. The original PPACA bill would have eliminated the cuts resulting from the 1997 SGR formula, but at conservatives’ insistence this provision was taken out. But when Democrats attempted, first, to repeal SGR in a separate bill, and then to pass the usual one-year “doc fix” to postpone the cuts another year, it was Republicans who blocked it.
And it’s too obvious that the reason Republicans wouldn’t stop the rate cuts is that they could be blamed on “Obamacare,” even though they aren’t the fault of “Obamacare.”
The cuts to Medicare in PPACA were mostly to Medicare Advantage, a popular program that unfortunately costs taxpayers more than regular Medicare. However, from what I can glean from this fact sheet from the Congressional Research Service, PPACA as passed does not directly address the basic physician reimbursement rates in regular Medicare that people are complaining about. Instead, it establishes a Medicare Payment Advisory Commission to report to Congress in March of every year recommending what adjustments might be needed to the rate. But we haven’t heard from the MedPAC yet, and I’m not sure if it’s even been appointed.
Beside trimming back Medicare Advantage, the other major cost-saving Medicare plan in PPACA is to “bundle” hospital payments — instead of reimbursing for every individual procedure, hospitals will be reimbursed for treating a person’s condition over a period of time — X amount for six months of diabetes treatment, for example. This should eliminate hospitals’ padding their profits with unnecessary procedures.
But if the 23 percent cut isn’t stopped, could cause massive disruption in seniors’ health care. Perhaps since the midterm elections are done, the GOP will relent and at least go along with a temporary “doc fix” and kick the can down the road another year. But I suspect it’s going to be awfully tempting for them to block the fix one more time, because it’s all too easy to persuade the peabrains who support them that it’s all Obama’s fault. And if it puts some of the older folks at risk, it’s all for the glorious Republican cause.
See also Ron Chusid.