I spoke to two members of Congress, in the House of Representatives, about the major legislative issues affecting you and your peers. Namely, the Medicare physician pay cut and the future of health reform. Here are edited transcripts of my phone conversation with Rep. Michael Burgess (R-Texas) and my email exchange with Rep. Diana DeGette (D-Colorado).
Rep. Michael Burgess is a Republican member of the House Energy Committee Subcommittee on Health.
Part B News: How high of a priority is addressing the upcoming Medicare physician pay cut to you and other Republicans in Congress?
Rep. Burgess: This issue will be taken very seriously. But given the way the Democrats have behaved [on the pay fix in June] ... I've felt that the best we could hope for out of the lame-duck Congress is a one or two-month fix that lands us into January or February.
Part B News: What will you personally push to do during the lame-duck session as far as the pay cut?
Rep. Burgess: Well, I've had [a sustainable growth rate or SGR] repeal bill out there every year I've been in Congress. In my way of thinking, it's money that's already been spent. We've got to avoid the same scenario that exhibited itself over the summer. We're going to try and do whatever it takes to keep people intact through the end of the year.
Part B News: Would you agree that both parties agree the pay cut is not acceptable and that the only partisan issue is how to offset the cost?
Rep. Burgess: I don't know about that part. We had a late fix over the summer. That was a disaster ... thanks to Democrats behaving so badly. I understand there are people on my side who are nervous about the deficit numbers. But we know where the offsets can be found, none of them are easy to make.
Part B News: Can you give me some examples, specific things to cut to cover the costs of the fix?
Rep. Burgess: Well, I'm not going to be drawn into a debate with myself over this or that specific item. There are published lists out there and there's not a single one of them that's an easy choice, every one of them comes with a political consequence.
Part B News: How do you think the outcome of the midterm elections affect the pay-fix issue?
Rep. Burgess: What I've been asking my side to consider is "what would an SGR solution look like to you and how could we best get there? Does it look like a fee-based model or based on bundling model, or PQRI model, or ACO model, or medical home model?"
Part B News: Have you had any conversations about a permanent fix with Rep. John Boehner, the presumptive House Majority Leader?
Rep. Burgess: I've heard him say it would be [a priority and addressed] in the past and I take him at his word.
Part B News: How about repealing the health reform law? There are already many parts of it that have turned into CMS regulations via the final physician fee schedule.
Rep. Burgess: First of all, none of that rulemaking has been subject to any Congressional oversight. The fact that Kathleen Sebelius hasn't come to Congress, that Administrator [Donald] Berwick hasn't come to testify ... on any of these specifics that are becoming regulation, is an affront to the legislative branch.
Part B News: You don't think there are any elements of the reform law that are worth keeping?
Rep. Burgess: There is no part of it that's worth saving. There may be areas of broad agreement ... but I think full repeal needs to come to the floor of the House and the floor of the Senate in short order.
Part B News: I'm talking about very specific provisions like the new annual wellness visit, the waived copays on preventive services, things that have not been very controversial that Democrats say the public wants.
Rep. Burgess: You didn't need a trillion-dollar bill to get an annual wellness visit. You didn't need a 2,700-page bill to do these things. I don't buy into the fact that in order to get wellness visits, I need to sign on to pass a trillion-dollar bill.
Rep. Diana DeGette is the Democratic chief deputy whip in the House and also a member of the House Energy Committee Subcommittee on Health.
Part B News: How high of a priority is addressing the upcoming 23% cut to physician payments for Medicare services?
Rep. DeGette: Addressing this cut is very high on our list of priorities. We recognize that allowing it to expire would have a significant effect on individual doctors and patients, as well as the rest of the health care industry. I believe there is a strong sentiment to address the reduction before the previous extension expires.
Part B News: What legislative action would you take over the next two months to address the pay cut? How long of a temporary fix would you support?
Rep. DeGette: I have supported in the past, and will continue to support, a permanent fix as opposed to a temporary one. In the version of the Affordable Care Act that passed the House of Representatives, we had a permanent fix that was not included in the Senate legislation. Attempts to revive that solution have foundered because of concerns over funding. As we discuss an extension moving forward I will continue to push for a permanent solution such as the one included in the House bill that replaced the sustainable growth rate formula with a new formula for evaluating and updating physician reimbursement.
Part B News: How would you fund a temporary "fix"? What is the best permanent solution to temporary fixes?
Rep. DeGette: I believe that any new funding should comply with the House's Pay-as-you-Go rules, and that we should explore ways to raise revenue elsewhere to offset the costs of a permanent extension.
Part B News: Regarding the health reform law, there are numerous provisions that have aroused less controversy, and are already being codified into HHS rulemaking via the 2011 Physician Fee Schedule. How likely would it be for Republicans to threaten these with repeal? We're talking items like waiving copays for preventive services for seniors, and a new annual wellness visit for seniors, also free.
Rep. DeGette: Unfortunately I cannot speak to what the Republicans intend to do once they assume control of the House of Representatives. As different repeal scenarios are discussed, however, it is important to remember that the discharge petition that 173 members of the House - including presumptive Speaker John Boehner - have signed is an outright repeal of health reform. While Republican leadership talks about restoring the popular components of the bill, the immediate effect would be to reinstitute copays for preventative services, do away with the free annual wellness visit for seniors, and once again preclude children with preexisting conditions from finding health insurance. With that understood, I feel strongly that any effort by House Republicans to repeal the bill will not go over well outside of Washington, and they ultimately do so at their own peril.
Part B News: How would repealing various portions of the reform bill affect physicians and health care providers?
Rep. DeGette: As the cost of providing care continues to rise, physicians and health care providers need more certainty, not less. This administration and the Democrats in Congress remain committed to providing this certainty, and the Affordable Care Act creates a more predictable marketplace. As Republicans attempt to square their competing notions of maintaining the expanded access to care provided for under the legislation, while slashing federal financial commitments, many of the structural and financials costs of even a partial repeal would fall squarely on the shoulders of health care providers.