Despite what you may hear in the media these days, a lot has been happening on Capitol Hill – on a range of important health policy issues not called “repeal and replace”. The “sturm and drang” that seems so prevalent in American politics is still ever present, but the idea that this has paralyzed action on major health policy issues is misleading.
While much of the media was focused on who to blame for the government “shut down” a few weeks ago, the Congress quietly inserted a 5-year reauthorization of the Children’s Health Insurance Program (CHIP) on the Continuing Resolution that “reopened” the government. The Congress also postponed several Affordable Care Act taxes that had been scheduled to take effect in 2019 as part of that package – major changes largely ignored by the popular media.
Early Friday morning, Feb. 9, the Congress passed and the President signed another “Continuing Resolution” to avoid a “government shutdown” and once again, Congress included several major changes in Medicare policy.
This new bi-partisan budget deal, lifts the so-called “budget caps” and provides a two-year funding outline. Included are numerous changes to the Medicare program that have been promoted by organized medicine and the hospital and patient communities, including the College’s Advocacy Council.
Most notably, Congress relaxed some of the MIPS thresholds that will mean thousands of physicians who were likely going to be hit with MIPS-related Medicare payment cuts in 2020, will now be able to avoid those reductions. The budget deal also repealed the Independent Payment Advisory Board; extended a number of “expiring” Medicare provisions – including the extension of the geographic payment adjustment floor to preserve Medicare Part B payments for rural providers; further extended the authorization of CHIP until 2027; repealed the cap on therapy payments; promoted more “team-based” care; and many other changes to Medicare.
But the same Congress that “giveth” also “taketh away”. The 2% Medicare sequestration cut that was technically set to expire at the end of 2025, has been extended for another two years – until 2027. Furthermore, the .5% update to the Medicare Physician Fee Schedule Conversion Factor that was scheduled to take effect on January 1, 2019 has been reduced to .25%.
Much of the rhetoric that infects our political dialogue is often just that – rhetoric. Serious negotiations do not occur in the newspaper or on Sunday talk shows, or even on the floor of the House or Senate. Policy making occurs in offices far-removed from the public square where serious people interested in serious policy-matters work behind the scenes to promote policies that try to improve the lives of most Americans.
The fact that a package of this magnitude has come – seemingly (to some) out of nowhere – is further evidence that policymaking is not “dead” in Washington and further evidence that when properly motivated, bi-partisan agreement can be achieved – even in Washington, DC.