Short Takes On News & Events

Using War Savings For ‘Doc Fix’ Complicated By Congressional Rules

By Mary Agnes Carey

February 3rd, 2012, 6:00 AM

While hospitals, physicians and some members of Congress want to use war savings as a way to get rid of Medicare’s sustainable growth rate formula, congressional rules could complicate things.

Photo by Leo Reynolds via Flickr

Even if there’s enough support for the idea among Republicans — and it’s unclear there is, especially in the House – there’s the issue of “scope,” or what’s currently included in the House and Senate bills.   Neither measure to extend the payroll tax cut and unemployment benefits and prevent Medicare physicians from getting a 27 percent pay cut through this month relies on the war savings – formally known as the Overseas Contingency Operations fund. And that’s an issue for Rep. Dave Camp, R-Mich., who chairs the House-Senate conference committee trying to resolve differences between the two measures.

“My view is it’s outside the scope of conference,” said Camp, who also chairs the House Ways and Means Committee. “It’s not in either the House or Senate bill at this point.”

If conferees went ahead and used the fund, it could cause problems when the legislation came to the floor if members chose to raise a point of order in objection. That is often more of an issue in the Senate than the House, where budget points of order are often waived before legislation is brought to the floor.

Such objections would be unlikely to succeed, since party leaders seldom bring a bill to the floor for a vote unless there are enough votes committed to pass the measure. And even if tried, there would probably not be enough votes to sustain it.

A related issue in using OCO funds to get rid of the SGR may be the precedent it would set.  “In the future, for other conferences, they might bring something into a conference that’s outside of its jurisdiction,” said G. William Hoagland, vice president of public policy for Cigna who previously served as a top Republican staff member of the Senate Budget Committee.  “The risk is, does it set up a precedent for the future that goes beyond this conference? That’s the danger.”

A second challenge to using the war savings to finance the “doc fix” is that that money is discretionary spending and Medicare falls under mandatory spending. Using discretionary funds to pay for mandatory spending would violate congressional pay-as-you-go rules, according to Congressional Budget Office Director Douglas Elmendorf.  Conservative Republicans who ran on a platform of fiscal responsibility may be reluctant to waive budget rules to accommodate new federal spending, especially in an election year.

But again, if House and Senate leaders have the votes to pass the measure, they likely have the votes to get around that issue. It’s important to remember, however, that in the Senate, backers would need a supermajority of 60 votes to succeed.

In a blog post published Wednesday, Elmendorf also notes that since OCO spending is set one year at a time, and has been provided only through 2012, future projections of the fund are just that — projections. “The funding has not yet been provided,” he writes, “and there is no ‘OCO fund’ set aside in the Treasury from which resources can be drawn in future years.”

6 Responses to “Using War Savings For ‘Doc Fix’ Complicated By Congressional Rules”

  1. Rich says:

    Here’s my “doc fix” suggestion…

    When a doctor refuses to treat a Medicare patient, that doctor should be excluded from participating in Medicare ever again. As Accountable Care Organizations (ACO) begin to swallow up the solo practices, HHS should provide incentives for our Medicare patients to migrate into the ACO model and let the solo practices dry up and blow away. The time for greed is over. There is nothing more immoral than to frighten the elderly and use them as pawns while doctors continue to satisfy their appetite for wealth. Our seniors deserve more respect than that. Our seniors deserve a break. Today’s doctors treat our seniors with abuse and disrespect. These greedy doctors deserve to be banned from Medicare participation.

  2. Nick says:

    Solo practice doctors shouldn’t be casted so negatively. My community has seen the personal physician and all its’ plus’ replaced by every increasingly impersonal organizations that couldn’t be compared in quality of care. Question: had the mega pharmacy proved any more ethical than the solo pharmicist? From another view
    ACO appear to be most concerned with accounting not quality care. Naturally, as gov incentives provoke the “cashing in ” by mega group practices, business models change.
    Now its’ even more about money. Indignation may blurry the issues.

  3. AMA says:

    Physicians care deeply about their patients and want to continue providing care for seniors in the Medicare program and military families who rely on TRICARE. Access to health care is currently threatened for these patients because of a drastic 27 percent cut scheduled for March 1. Medicare physician payments have already been nearly frozen for a decade, while the cost of caring for patients has increased by more than 20 percent. Medicare’s own advisory committee has said that 22 percent of seniors seeking a new primary care physician in Medicare had trouble finding one. This cut would only make matters worse and force many physicians to limit the number of Medicare and TRICARE patients in their practices. Physicians are fighting to have this problem eliminated to protect access to health care for seniors and military families.

    To stop this and future cuts, Congress should use projected spending for the wars in Afghanistan and Iraq to eliminate this problem — without adding to the nation’s deficit. This solution would help military members and their families, as well as our nation’s seniors, maintain access to health care. The projected war funds will be used for something. Using them to pay for a debt we already owe is the common sense, fiscally responsible solution. Otherwise, Congress will patch this problem once again and increase the price tag for taxpayers and the problem for patients.

  4. Rich says:

    Providers in the health care industry have milked the cow dry. Seniors have nothing more to give. The cow is on life support! If docs get more to treat Medicare patients, Medicare patients will eventually pay more. Seniors are on fixed incomes. We have no more to give! If doctors refuse to treat seniors, maybe nurses will step up to the challenge. Maybe we need more neighborhood clinics that are staffed by nursing professionals. Maybe we need to go to a VA style of health care for seniors. Maybe we need a military style of health care for seniors. The private health care industry has failed seniors and they keep asking for more. The greed is outrageous! We need to change health care delivery for seniors. Seniors are tired of being treated like dirt.

  5. JWH says:

    Many good comments shared above ~ however, physician reimbursement increased over the last decade. It is more important to look at how Relative Value Units changed instead. Second, no one is required by law to join or participate in an ACO. Billions may be spent by hospitals to build something few will have interest to participate. There is no proof that ACO’s will work. It is pure theory and expense. It is maybe so or aybe not and maybe, maybe. As one politician stated recently, “when the government funds more in healthcare dollars, the costs just continue to rise.” Finally, physicians choose their profession to help and to make money just like all of do or have ~ and rightfully so. Times change. Perhaps the solution is not to sustain the reimbursements but to let them fall lower. No one complained about the SGR when reimbursements kept going up. Physicians who threaten to opt out of Medicare will also be opting out of Medicaid and Medicare. If so foolish, they would lose up to 40% of their patient base or more. Most working Americans experienced very small if any wage growth since 2000. It percolates up of course, affecting other professionals eventually ~ physicians, attorneys, etc. Thank You!

  6. JWH says:

    Just a correction ~ when opting out of Medicare, TriCare drops the physician automatically.