Brookings Institution Briefing

SGR Repeal Faces Uphill Climb, Say House Members

February 05, 2015 07:45 pm Michael Laff Washington, D.C. –

Reps. Gene Green, D-Texas, left, and Michael Burgess, R-Texas, discuss the prospects for repeal of the Medicare sustainable growth rate.

Two House lawmakers who are strong advocates for repealing the Medicare sustainable growth rate (SGR) said they are racing against a tight deadline to avoid steep cuts in physician payments.

Reps. Michael Burgess, R-Texas, and Gene Green, D-Texas, met recently with a small gathering of media and medical professionals during an event hosted by the Brookings Institution to discuss their latest efforts to address potential Medicare payment cuts. Both are members of the House Energy and Commerce Committee's Subcommittee on Health.

Burgess said legislation calling for full SGR repeal will be introduced in the House "shortly" with language similar to wording in a bill that won bipartisan support in 2014 but, ultimately, did not pass because the House and Senate could not agree on how to pay for it with budget cuts in other areas, known as "offsets."

Also During the Briefing

Don't miss AAFP News coverage of a panel of experts, including AAFP Board Chair Reid Blackwelder, M.D., discussing alternative payment models, such as the patient-centered medical home.

"The bill will be offset," Burgess said. "There aren't enough votes in the House to pass it without them. You can't peel off Republicans to pass it."

In lieu of full repeal, Congress passed a one-year extension of the SGR, or "doc fix," that expires on March 31. Congress begins its spring recess on March 25, however, leaving less than two months to resolve the issue before the SGR formula cuts the Medicare physician payment rate by 21 percent.

Burgess and Green said there is no partisan debate about repealing the SGR, only disagreement about how to pay for it. "I don't know one member in the House who would stand up and say, 'I want the SGR (to continue),'" Green said.

But the two legislators did caution that with such a short deadline to meet, a full repeal faces long odds.

"It's going to be difficult to get this (full repeal) through the House and the Senate on a short timeline when we had all of last year to do it," said Green. "I can't tell you we won't have to do a (temporary) fix. Paying for it (repeal) will be the issue. We're not going to take away Medicare benefits to seniors to pay for it. It needs to be fair and not hurt beneficiaries.

The 17 short-term patches applied to avoid SGR-mandated pay cuts over the years have cost $169.5 billion. That's far more than a total repeal, which the Congressional Budget Office estimates would cost $131 billion.

Burgess and Green said intense lobbying efforts by medical organizations brought the issue to elected officials' attention, and that ongoing advocacy is pushing legislators to act. "You've made it uncomfortable," Burgess said. "You've done your job. We took your suggestions to heart. It was not a closed-door process."

Burgess said he first learned about the SGR when he filed to run for Congress 12 years ago. Shortly after entering the House, Burgess was told that the SGR was a budgeting issue that would be handled without much rancor. It turned into much more. The issue came to define his career, and he has introduced a bill every year calling for its repeal.

"I'd rather not hold any more hearings on SGR," Burgess said, referencing two days of hearings the House recently held on the issue. "I'd rather talk about vaccination rates than how to pay for something we should have taken care of a long time ago."