Washington Health Policy Week in Review Compromise 'Doc Fix' Bill Scored by CBO

The bipartisan, bicameral compromise measure to replace how Medicare pays physicians would cost $138.4 billion for 2014 through 2024, according to the latest Congressional Budget Office (CBO) estimate, and lawmakers are struggling to find a way to pay for it.

The score is on the lower side of cost estimates for various measures that would repeal Medicare's sustainable growth rate and replace it with new payment systems. The bill (HR 4015, S 2000) represents a policy agreement among three committees—Senate Finance, House Energy and Commerce and House Ways and Means—and has the backing of several provider groups.

The CBO noted that this most recent estimate is an 11-year score and includes a cost for fiscal 2024, whereas all the previous scores included costs only through fiscal 2023. Through fiscal 2023, the compromise bill would cost $122.3 billion.

Previous versions of replacement legislation approved in committee had CBO cost estimates ranging from $121.1 billion over 10 years to $153.2 billion over 10 years.

But a more immediate problem looms—lawmakers have only one month before the current "doc fix" patch (PL 113-67) expires and physicians face a 24 percent cut in their Medicare payment rates beginning April 1.

Rep. Charles W. Boustany, R-La., has said that lawmakers are working on a "parallel track"—continuing to work on moving the replace bill forward while also coming up with another short-term patch that could perhaps last through the rest of 2014.

"What's complicating things right now is the discussion on payfors," said Boustany, noting that new Senate Finance Committee Chairman Ron Wyden, D-Ore., is still "staffing up." Wyden became chairman earlier this month when Max Baucus, D-Mont., left the Senate to become ambassador to China.