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This week’s headline:

Clock ticking on Medicare reform bill

Time is running out for Congress to avoid another temporary patch to Medicare payment reform, and the prospect for Congress to reach an agreement to pass and enact the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, HR 4015/S 2000 has dimmed. If Congress does not act by March 31, a 24 percent across-the-board cut to Medicare physician payments will go into effect on April 1, 2014. While the original version of HR 4015/S 2000 was the result of bipartisan negotiations to repeal the flawed sustainable growth rate (SGR) formula, the bill did not identify fiscal offsets to pay for the cost of SGR repeal and reform.

Action in the House
On March 14, the U.S. House of Representatives passed HR 4015 in a 238 to 131 vote. Before its adoption, House Republican leadership added a provision that offsets the cost of the bill by delaying the Affordable Care Act (ACA) mandate that requires individuals to have health insurance. The Senate Democratic majority and the White House have indicated that they will not accept this provision to pay for SGR repeal, meaning that the bill — as passed by the House — cannot clear the Senate and will not be adopted into law.

Action in the Senate
On March 11, Senate Finance Committee Chairman Ron Wyden (D-Ore.) introduced the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 (S 2110), which includes the bipartisan reform provisions of S 2000 along with additional Medicare and Medicaid provisions. Like S 2000, S 2110 does not include provisions offsetting the cost of reform. Senate Republicans indicated they could not support legislation that does not include offsets. Senate Finance Ranking Member Orrin Hatch (R-Utah) followed by introducing S 2122, which would offset the cost of SGR repeal with repeal of the individual mandate. While Senate Majority Leader Harry Reid (D-Nev.) has filed S 2110 for possible action, it appears unlikely the legislation will receive the support needed to clear the Senate. In addition, the lack of fiscal offsets in S 2110 makes it unlikely that the House will pass the bill.

Next steps
With only a few days left before the March 31 deadline, it is possible that Congress will consider another short-term reprieve within the coming days to avoid the 24 percent cut on April 1. The AADA supports HR 4015/S 2000 and is committed to finalizing a permanent solution, and urges Congress to immediately address this problem by enacting a long-term solution that can garner bipartisan support and be signed into law. The AADA is calling on all members to log on to the AADA Dermatology Advocacy Network and submit a letter urging Congress to reform the Medicare physician payment system now.

The AADA will continue to provide updates as information becomes available. For more information on Medicare payment reform, contact Shawn Friesen at sfriesen@aad.org.

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