Time is running out. After weeks of disagreement, Congress and the White House have not reached common ground on the federal debt-ceiling limit.
The United States reached its borrowing limit in May. Since then, the U.S Treasury has taken measures to ensure that the federal government can meet its financial obligations -- such as Medicare physician payments -- without adding to the national debt. According to estimates by Treasury officials, those measures will be exhausted by Oct. 17. Thus, the nation enters its third week with much of the federal government shut down, no agreement in place to address the debt ceiling, and little time left for legislators and the Obama administration to reach a compromise.
If the U.S. government cannot borrow to pay its current bills, there likely will be grave consequences for the national and world economies. In health care, it likely could create a crisis situation for beneficiaries who depend on programs such as Medicare, Medicaid and Social Security. Medicare payments due to be paid on Oct. 17 likely would be delayed by one to five days if the debt ceiling is not addressed, according to the Bipartisan Policy Center. If the debt ceiling is not lifted by that date, the government would be forced to stop, limit or delay payment on a broad range of its obligations, including physician payments.
Treasury Secretary Jacob Lew told the Senate Finance Committee Oct. 10 that failing to raise the debt ceiling before Oct. 17 would cause physicians who treat Medicare patients to operate with "significant uncertainty about when they would be paid" for their services. He also said health care professionals would face "real liquidity challenges."
Meanwhile, the ongoing debate about the budget has kept much of the federal government shuttered. That means our nation's food supply is still at risk; our ability to track foodborne illnesses, influenza and other diseases is stifled; and new patients aren't being admitted to clinical trials because thousands of workers from the CDC, FDA, NIH and U.S. Department of Agriculture, as well as other government agencies, are sitting at home waiting for Congress to do its job so that they can get back to doing theirs.
Will Congress wait until the last minute before averting a default on U.S. debt? Or will it scramble for a solution after the fact? This 11th hour brinksmanship is the kind of performance we have come to expect from a Congress that, time after time, has resorted to short-term, temporary extensions to the sustainable growth rate (SGR) formula rather than offering an actual solution.
If Congress manages to avoid default and reopen the government, it still will have to deal with the issue of the SGR and a nearly 25 percent Medicare physician pay cut scheduled for Jan. 1.
By destabilizing Medicare, Congress threatens the financial viability of primary care practices. More importantly, millions of elderly and disabled Americans depend on a stable Medicare system that ensures they have access to the physicians they need. They are the ones who suffer when Congress cannot act, and the problems they face because of an unstable health care system will last long after the current impasse is resolved.
What can we do about it?
Contact your legislators and President Obama. Tell them to stop arguing and work toward solutions for the people they represent, including you and your patients.
Congress contends that it wants to improve the quality and reduce the costs of health care, but closing government health agencies and causing instability in essential health care programs are at odds with those goals. Congress must increase the debt limit and restore stability to Medicare. Our patients and our practices depend on it.
Reid Blackwelder, M.D., is president of the AAFP.