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Pelosi Not Moving Last-Minute Doc Fix Bill

Before the Senate left last week, they tried to salvage something out of the stalled jobs/extenders bill by passing a six-month extension of the “doctor’s fix,” offsetting a scheduled 21% cut to doctors in Medicare reimbursement rates and actually giving them a 2% increase for those six months. The $6.4 billion cost was fully paid for through changes to hospital reimbursement rates.

Well, that didn’t sit with Nancy Pelosi’s vision for a jobs/extenders bill, so she vowed not to pass it.

But Pelosi said late Friday that the Senate-passed bill was “a great disappointment” and she saw “no reason to pass” it.

“The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs,” Pelosi said in a statement. “The House has repeatedly sent jobs—creating bills to the Senate since December—Build America Bonds, small business hiring incentives, and importantly, summer jobs—and yet Republicans continue to block approval of jobs legislation.”

Decoupling the doc fix takes one incentive for Republicans to pass the jobs/extenders bill out of the equation, and would arguably make it harder to get that done.

The longer that Congress waits to restore the “doc fix,” which expired on June 1, the harder it gets, because now it’s baked into the status quo and would require deficit spending to reverse it unless it gets offset.

Trade associations for doctors sound completely fed up, and are openly talking about closing their doors to Medicare patients, their piece of leverage in this ongoing fight. Pelosi could be playing on that to break down Senate Republicans to pass the extenders/jobs bill; a couple Republicans and conservative Democrats are all that’s holding it back in the Senate.

The American College of Physicians warned that Congress is “playing with fire” by messing around with short-term fixes and delayed payments.

“I have never seen physicians more frustrated with the cuts and cynical about Congress’ willingness or ability to do the right thing for patient access,” said Bob Doherty, a senior vice president at the American College of Physicians. A short-term repair “will confirm the growing sentiment among doctors and seniors that Medicare is an unreliable and unstable partner that can’t be counted on to pay its bills, and more of them accordingly will limit how many Medicare patients and seniors they can afford to see.”

The American Medical Association says it has run out of patience.

“This is no way to run a major health coverage program – already the instability caused by repeated short-term delays is taking its toll,” said AMA president Cecil B. Wilson. “Congress has finally taken its game of brinkmanship too far, as the steep 21 percent cut is now in effect and physicians will be forced to make difficult practice changes to keep their practice doors open.”

It’s fairly dangerous for Pelosi to dare the Senate to pass a real bill, but she’s passed this bill over and over and over again. The Senate could probably use some pressure. Liberal groups are working to apply it as well, with an ad up in Maine targeting Olympia Snowe and Susan Collins on the bill.

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David Dayen

David Dayen