Now that the Senate bill has been slated for passage this week, the major stakeholders in the debate have begun to shift their attention to the upcoming conference committee to combine the bills from both houses—and some are already bringing their demands to the table. As Mike Lillis notes, the American Medical Association declared yesterday that it would support the Senate bill, but declared that it would to turn against the bill next year if Democrats failed to lay the groundwork for a long-term fix of the flawed Medicare reimbursement formula, known as the Sustainable Growth Rate formula. While the AMA praised the Senate bill for “making important strides toward providing affordable, high-quality health care,” it made no secret of its threat: “We will not support a final Conference Report without a clear pathway for passage of a permanent repeal of the SGR formula early next year.”
The reality is that it’s highly unlikely that the Democrats will be able to pull off a permanent Medicare “doc fix” while they’re still trying to push through the main health-care bill. Although there’s widespread—and, yes, bipartisan—agreement that the Medicare reimbursement system for doctors is flawed, the price-tag for the fix is quite steep: the version that the House passed was $210 billion, with no offsets, and the difficulty of financing the legislation led the Senate version to fail a few months ago. Recognizing these challenges, the AMA has hedged its demand by asking the Democrats provide a “clear pathway” for a doc fix rather than the passage of the bill itself. But whether they’d be satisfied with a promise by the Democrats to address the issue later, or if they’d demand something more concrete within the existing bill, remains unclear.
Should the Democrats fail to live up to the AMA’s expectations on this front, would the doctors actually make good on their threat to jettison reform—and would such opposition really have an impact on the passage of the final bill when it returns to the House and Senate? While interest group opposition could have been disastrous months earlier in the process, when attack ad-buys and other negative tactics could have changed the tenor of the debate, it’s uncertain whether such a move would have the same impact at this point. Moreover, the Senate leadership has already given indications that it will try to extract more from interest and industry groups in conference—promising, for instance, to close to Medicare donut hole in conference despite Big Pharma’s opposition. In the final stretch, Democrats may be willing to risk taking on the heat.
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Suzy Khimm is a senior editor at The New Republic.