Medicare ‘doc fix,’ passed by House, shifts some costs to seniors

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Image by 401(K) 2012 via Flickr

Image by 401(K) 2012 via Flickr

The U.S. House of Representatives passed H.R. 2 on Thursday, a bill that would prevent an automatic cut of 21 percent in Medicare payments to physicians and would require seniors to pay more in the form of higher copayments and premiums. The Medicare Access and CHIP Reauthorization Act of 2015 also would extend the Children’s Health Insurance Program (CHIP) for two years through 2017.

The vote was hailed as a step forward for physicians because it eliminates the formula Congress has used for many years to increase payments to physicians. That formula, called the sustainable growth rate (SGR), was renegotiated annually and usually at the last minute. It’s been replaced with an annual payment increase of 0.5 percent. The vote was 392 to 37, including 212 Republicans and 180 Democrats voting in favor, according to Govtrack.us.

The strong support from both Republicans and Democrats puts pressure on the U.S. Senate to approve the bill, before Congress adjourns on Friday, Paul Demko wrote in Modern Healthcare.

Passage in the Senate is uncertain, he added, because there’s not much time, especially given that the Senate also needs to pass a budget before adjourning. President Obama said earlier in the week that he would sign the bill.

In Oncology Times, Lola Butcher reported that oncologists were glad to see the SGR eliminated and that the bill would raise Medicare payment rates for physician services by 0.5 percent each year between 2016 and 2019. Starting in 2019, it will change how physicians are paid by giving them a financial reward for delivering high-value care and penalizing them for failing to do so.

Writing for Reuters, Mark Miller explained that the bill will cost an estimated $200 billion over 10 years, an amount Congress has not determined how to cover. But Medicare beneficiaries will pay for $70 billion of it in the form of higher copayments and premiums, he said.

Miller also explained that under the plan, new Medicare enrollees would no long be able to use Medigap insurance plans to cover their deductibles. Instead, starting in 2020, they will have to pay their own deductibles. Other changes require higher-income beneficiaries to pay more, and all seniors to pay higher premiums.

AARP praised the bill but said it was concerned about the increased costs for seniors and would work with the Senate to revise the bill.

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2 thoughts on “Medicare ‘doc fix,’ passed by House, shifts some costs to seniors

  1. Pingback: As it considers SGR fix, Senate weighs fundamental shifts to Medicare | Association of Health Care Journalists

  2. Pingback: Change to Medicare will shift physicians into value-based payment | Association of Health Care Journalists

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