We don’t need no stinking patches


Since 2003, Congress has repeatedly stepped in — sometimes multiple times per year, sometimes retro- actively — to block the growing Medicare physician pay cuts mandated by the Sustainable Growth Rate (SGR) formula, knowing the reductions threaten seniors’ access to care. Meanwhile, the cumulative cost of the fiscal cliffs outweighs the cost of fixing the problem once and for all.


Year


2003 2004 2005 2006 2007


2008 (Jan.–June) 2008 (July–Dec.) 2009


2010 (Jan.–Feb.) 2010 (March)


2010 (April–May) 2010 (June–Nov.) 2010 (Dec.) 2011


2012 (Jan.–Feb.)


Scheduled Cut -4.4% -4.5% -3.3% -4.4% -5.0% -10.1% -10.6% n/a†


-21.3% -21.3% -21.3% -21.3% -21.3% -25.0% -27.4%


2012 (March–Dec.) -27.4% 2013 2014


-26.5% -24.0%


Actual Update 1.4% 1.5% 1.5% 0.2% 0.5% 0.0% 0.0% 1.1%


0.0% 0.0% 0.0% 2.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.5%


Cost* $54,000,000,000 $200,000,000 (2004 & 2005)


$-400,000,000 $3,100,000,000 $6,400,000,000


$9,400,000,000 (includes 2009)


$2,000,000,000 $1,000,000,000 $2,000,000,000 $6,000,000,000 $1,000,000,000 $14,900,000,000 $3,600,000,000 $18,000,000,000 $25,200,000,000


$7,300,000,000 (3 months) Total spent on SGR patches Cost of proposed SGR repeal and replacement legislation


$153,700,000,000 $138,000,000,000‡


*All cost scores are 10-year Congressional Budget Office (CBO) estimates. †Not applicable; the last 2008 legislation included the 2009 delay. ‡Feb. 27, 2014, CBO score of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014. Sources: Congressional Research Service, American Medical Association, Texas Medical Association


24 TEXAS MEDICINE June 2014


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