College of American Pathologists
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December 16, 2011
© 2011 College of American Pathologists
Special Report
Congress Swings Into Year-End Action, SGR, TC Grandfather Still Uncertain

December 16—After spending the week focusing on partisan differences, Congress finally got to work yesterday on two bills that must be approved before year end or face major disruptions. The first, a $1 trillion+ spending bill, is needed to continue funding the government into next year. The other extends key entitlement programs including the Social Security payroll tax holiday, as well as provisions to fix the flawed Sustainable Growth Rate (SGR) formula and extend key Medicare provisions.

As of this writing, the House Appropriations Committee announced the bill to avert a government shutdown will be filed today, with votes in the House and Senate scheduled possibly as early as tonight. However, Congress has not reached consensus on some of the provisions in the smaller entitlement bill, and leaders announced they will likely pass a two-month extension at the cost of $40 billion, to allow more time to iron out the details. For pathologists, this means two key issues, the SGR and the TC-Grandfather will in all likelihood remain undecided.

Throughout this budget process, CAP members met with over 75 Member of Congress to lobby on three main issues: fixing the SGR, extending the TC “grandfather” provision, and ending physician self-referral of anatomic pathology services. Congress chose not to address the self-referral issue, although both the TC-grandfather and SGR provisions which expire on December 31, 2011, are still very much in play.

Just this week the College spearheaded a coalition of organizations who lobbied the influential House Ways and Means Committee to extend the TC Grandfather, although the committee omitted it from the package of Medicare extenders passed in the House earlier this week. The bill, Middle Class Tax Relief and Job Creation Act of 2011, (H.R. 3630), is a Republican-drafted bill that would extend the Social Security payroll tax cut, reform and extend unemployment insurance, and provide a two-year SGR patch with 1 percent payment increases in 2012 and 2013.

Since being shut out in the Republican-backed House bill, the TC-Grandfather received support from Sen. John Boozman (R-AR), in a letter to Senators Max Baucus, (R-MT) and Orrin Hatch, (R-UT), the chairman and ranking member of the Senate Finance Committee. And CAP member Bruce Williams received a note from Sen. Mary Landrieu’s office expressing her continued support for the extension despite continued opposition from other House members.

Congress will also have to scramble to avert a 27.4% cut before adjourning for its holiday recess, scheduled to begin this weekend. Most pols and pundits believe Congress will act before the current patch expires on January 1, 2012, although the question remains, how much of a fix will it be, how long will it last, and how will it be paid for?

Earlier this week, the House legislation included controversial provisions, such as fast-tracking a permit decision on the Keystone XL oil sands pipeline, and limiting EPA regulations on air emissions.

The bill pays for these measures with $8 billion in cuts to the Patient Protection and Affordable Care Act (PPACA) prevention and public health fund; plus cuts to insurance exchange subsidies, increased Part B and Part D premiums for high-income beneficiaries, and payment cuts to hospitals. It also cuts the maximum unemployment coverage period to 59 weeks from the current 99 weeks by mid-2012.

Even before the House bill was passed, President Obama threatened a veto. In a White House statement he said, “Instead of working together to find a balanced approach that will actually pass both Houses of the Congress, H.R. 3630 instead represents a choice to refight old political battles over health care and introduce ideological issues into what should be a simple debate about cutting taxes for the middle class.”

Upon its passage, Senate Majority leader Harry Reid (D-NV) said, “The bill passed by House Republicans tonight is a pointless, partisan exercise. The Senate will not pass it and the President has said he will veto it.” As an alternative, it is looking increasingly likely that the Senate will propose a short-term physician payment patch, and hopefully address a longer term fix in the next 60 days. Much depends on the progress made in Congress today and possibly over the weekend.

Congress was scheduled to adjourn for its holiday recess today, however faced with a possible government shut down, expiring tax cuts and other issues still looming, the Senate will likely continue working through the weekend.

Statline will continue to track this story.

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