Reality and Unreality in the New Congressional Medicare (SGR) Deal

This week, you can be confident that the US Senate will approve bipartisan legislation approved on March 26 in the House of Representatives by an overwhelming (392-37) bipartisan majority to repeal a long-standing feature of Medicare physician payment policy called the Sustainable Growth Rate or SGR.

If you’ve never heard of SGR, you are among the 99%. Still, the SGR story has been fascinating and frustrating since it began as part of the 1997 Balanced Budget Act (BBA) agreed to by President Bill Clinton, House Speaker Newt Gingrich, and Senate Majority Leader Trent Lott.  And as SGR begins its final exit, a host of good and not-so-good elements in the repeal legislation come into play. Nancy+Pelosi+Congressional+Leaders+Honor+Fresco+DnF8pOwGvVhl

What’s good and what’s not so good about this deal?  Well, everything, depending on your point of view.  Here are the leading candidates (and my grade):

  • Repealing SGR – very good
  • Refinancing the Children’s Health Insurance Program (CHIP) for two years – very good (excellent if it were for four years)
  • Authorizing $7.2 billion for community health centers and the National Health Service Corps – wonderful!
  • Replacing SGR with a more sensible set of physician payment quality incentives (that follow the logic of the ACA, believe it or not) – very good
  • Not paying for the $141 billion 10-year cost of SGR repeal to the federal Treasury – not so good though worthy of forgiveness this time

So, wow.  Does this augur a new era of bipartisan Congressional cooperation on health policy?  Nope.  Let’s look at each of these in turn. Continue reading “Reality and Unreality in the New Congressional Medicare (SGR) Deal”