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As TMA gears up for the upcoming state legislative session, physicians are closely monitoring the im- pact of federal issues, from a nearly 30-percent cut in Medicare payment rates to implementation of the Patient Protection and Affordable Care Act (PPACA). Barring congressional action before this issue of

Texas Medicine went to press, this month physicians could see a 27.5-percent Medicare payment reduc- tion as a result of the Sustainable Growth Rate (SGR) formula. Add to that the possibility of another 2-per- cent Medicare cut slated to take effect under the 2011 Budget Control Act’s sequestration provisions as a result of federal lawmakers’ failure to address the national debt crisis. The country’s dire fiscal straits are indications that

“there is no money anywhere else that’s not already being used,” U.S. Rep. Michael Burgess, MD (R-Texas), told TMA members at the association’s Fall Con- ference in October. The situation also could mean PPACA implementation “will have to be delayed or sharply restructured.” In letters to congressional leaders, TMA, the Ameri- can Medical Association, and more than 100 state and specialty medical societies urged Congress not only to nullify the combination of impending Medicare cuts, but also to fix what physicians say is a flawed SGR formula that fails to keep up with the cost of care. “Now that the election is behind us, whether the SGR will get addressed, and how, are big questions on doctors’ minds,” said Dallas psychiatrist Leslie Secrest, MD, chair of TMA’s Council on Legislation. “Whatever that timeline is, we need a permanent solu- tion. At some point, this becomes a big enough crisis we have to solve it.” That time is now, physicians say. According to

TMA’s 2012 surveys, 58 percent of Texas doctors ac- cept all new Medicare patients, compared with 66 percent in 2010; only one third of doctors are willing to take all new Medicaid patients, compared with 42 percent two years ago.

Under PPACA, starting in 2013, the federal govern- ment will temporarily raise Medicaid rates to Medi- care parity for certain primary care physicians. But Medicare still pays only 80 to 85 percent of the cost of care, says Fort Worth pediatrician Gary Floyd, MD, a consultant to the Council on Legislation. Medicaid pays roughly 65 percent of care costs. “The irony to me is, if nothing is done about the SGR and Medicare rates drop, then the federal gov- ernment won’t have to increase Medicaid rates be- cause they will be almost equal,” he warned. “I’m left scratching my head and asking, is this really happen- ing? We will see more physicians drop out.” Federal health system reform already impacts

Texas’ budget and likely will “continue to consume resources for years to come,” said Sen. Jane Nelson (R-Flower Mound), chair of the Senate Committee on Health and Human Services. Gov. Rick Perry already informed the federal

government that Texas will not expand Medicaid as prescribed under PPACA. Nor will Texas establish a state-run health insurance exchange, which means it would be left to the federal government. Senator Nel- son “anticipates a discussion this session regarding whether in the future the state should assume control” of its exchange. House Public Health Committee Chair Rep. Lois

Kolkhorst (R-Brenham) said it is unlikely the legisla- ture will bend on expanding Medicaid until some re- forms to the costly program are implemented. Texas is working on implementing one Medicaid waiver allowing for the expansion of managed care and likely will seek other flexibility, she says. “But all of that is in the federal government’s court,”

Representative Kolkhorst said. Nevertheless, “with the PPACA likely moving forward, there has to be dis- cussion on our ability to meet the needs of primary care and how we address the uninsured population in Texas. This becomes a very real conversation in the next session.”

January 2013 TEXAS MEDICINE 27

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