Senate Majority Leader Mitch McConnell might be feeling some regret over
postponing a vote on the "doc fix" until after Easter recess. The Senate returns Monday and has
just a few days to get the bill passed before cuts in payments to doctors seeing Medicare patients kick in. That delay has
allowed for lobbying efforts designed at amending the legislation, and a
hardening of conservative opposition to it.
The main concern is from conservatives who are frustrated that two-thirds of the measure’s $214 billion cost would be financed through higher deficits and are looking at ways to pay for the measure without resorting to borrowing.
They're considering an
amendment that would require a full offset. They feel they've got new ammunition from the Centers for Medicare and Medicaid Services (CMS). The agency
released a report Friday explaining that what has been touted by House leadership as a "permanent" fix to the Medicare reimbursements problem really isn't so permanent.
"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 reality is that "permanent" applied to this issue can't ever be "permanent" because reimbursement rates are connected to too many other factors in the economy, so complaining about that is a red herring from conservatives. What they're going to look for are much steeper Medicare benefits cuts to pay for this, because that's always what they look for. Meanwhile, the benefit cuts in this current proposal—it asks for higher-income seniors to pay increased premiums—have led AARP to ask for an amendment.
The bill isn't expected on the Senate floor until Tuesday, when McConnell will have even less time to push it through. Either he's waiting until the last minute to pressure members into giving up on the idea of amending the bill and just accepting it as is (the White House says President Obama will sign it) or he's resigned to the idea of pushing one more short-term fix through. Kicking the can down the road is always an option in the Senate.