Congress' annual rite of passage to health care spending

Every December, Congress finds itself scrambling to approve spending bills and trying to tie up loose ends before the holidays. Just as sure as ornaments and lights adorn homes and malls during the holiday season and snowbirds head south for the winter, Congress burns the midnight oil to keep the federal government running, ensuring it pays its debts on time and staving off costly Medicare payment cuts to physicians and internal medicine late into the year. As Congress fails to address critical issues and/or kicks the can of resolving them down the road for another day, the problems of delivering quality health care to all Americans while ensuring our systems of payment remain viable are caught in this annual cycle of last-minute patches and temporary fixes. This is, after all, Congress' annual rite of passage.

Congress stepped up in December 2021 to avert a financial crisis by raising the national debt ceiling to allow the federal government to pay its bills until after the 2022 midterm elections. Congress also avoided disastrous Medicare pay cuts of nearly 10% to physicians that were set to occur on Jan. 1. These cuts would not only have negatively affected physicians, whose Medicare reimbursement has failed to keep up with the rate of inflation since 2000, but also curtailed patient access to quality health care.

ACP joined several coalitions and organizations in sending letters to congressional leadership urging them to pass legislation, such as the Supporting Medicare Providers Act of 2021, to extend the 3.75% payment applicable to the calendar year 2022 Medicare Physician Fee Schedule (MPFS) for an additional year. ACP led the Group of Six, a coalition of physician groups representing more than 690,000 physicians, in drafting a letter urging Congress to take action against the Medicare cuts as it considered a stopgap spending bill to keep the federal government running until Feb. 18. While the stopgap measure was not the vehicle used by Congress to address the Medicare cuts, ACP engaged its membership in a grassroots campaign to support S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act, which President Biden signed into law. In addition to raising the debt ceiling, that law will:

• Provide a three-month delay of the 2% Medicare sequester payment reductions (Jan. 1 to March 31) and a three-month, 1% reduction in Medicare sequester payment reductions (April 1 to June 30).
• Continue a one-year increase (through Dec. 31) in the MPFS conversion factor of 3%. This is applied across the board and without distinction to all payments under the MPFS and is a slight decrease from the 3.75% provided by Congress last year for FY 2021 under the Consolidated Appropriations Act of 2021, which ACP supported.
• Delay through 2023 the 4% Pay-As-You-Go cuts.
• Provide a one-year delay (through Dec. 31) of Medicare payment reductions to the clinical laboratory fee schedule and the private-payer laboratory data reporting requirements.

Yet unfinished business remains. Because Congress' stopgap spending bill expires on Feb. 18, it must pass either an appropriations bill to keep the government running, or another stopgap measure. ACP is urging Congress to approve the appropriations bill for FY 2022, which began last Oct. 1. ACP is supportive of appropriations being discussed that would increase funding for the U.S. Department of Veterans Affairs (VA), the CDC, the FDA, and the NIH. ACP is encouraging Congress to approve $103.1 billion in funding for FY 2022 for the Veterans Health Administration (VHA). That funding amount includes $66.2 billion for medical services, $20.7 billion for medical community care, and $902 million for medical and prosthetic research.

Democrats on the Senate Committee on Appropriations and its Labor, Health and Human Services, Education, and Related Agencies Subcommittee are considering the FY 2022 Labor-HHS-Ed Appropriations bill. Their draft language calls for $9.73 billion for the CDC, representing a $1.86 billion increase over the FY 2021 enacted level. Also under consideration are plans to 1) increase FY 2022 NIH funding to $47.99 billion (a $4.99 billion increase over the FY 2021 level); 2) authorize $9.1 billion for the Substance Abuse and Mental Health Services Administration, representing a $3.09 billion increase over the FY 2021 level; 3) authorize $1.79 billion for community health centers, an $110 million increase over the FY 2021 level; 4) authorize $50 million for medical student education, the same as the FY 2021 level; 5) authorize $48.92 million for primary care training and enhancement, the same as FY 2021; 6) authorize $50 million for firearm injury and mortality research at the CDC and NIH, doubling the appropriation for FY 2021; and 7) authorize $43.52 billion for the Public Health and Social Service Emergency Fund, representing a $1.17 billion increase over the FY 2021 level. However, final passage of appropriations legislation is subject to partisan bickering, and another short-term spending resolution may be needed to keep the government open beyond February. Each time Congress approves a stopgap spending measure, it keeps federal spending set at levels approved during the Trump Administration.

Congress is leaving other unfinished business on the table and needs to do more in addressing the shortage of physicians by increasing the number of graduate medical education (GME) slots. ACP fully supports the Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S. 834), which would create 14,000 new GME positions over seven years. Congress should pass bills to expand telehealth, protect women against violence, and curb abuse by law enforcement in racial and ethnic minority communities. ACP supports Congress passing the CONNECT for Health Act (H.R. 2903/S. 1512), which would permanently remove arbitrary geographic restrictions on where a patient must be located to utilize telehealth services, enable patients to continue to receive telehealth services in their homes, and ensure that federally qualified health centers and rural health centers can furnish telehealth services.

ACP is urging Congress to pass reauthorization of the Violence Against Women Act and enact the George Floyd Justice in Policing Act. These bills would afford greater protection to women who suffer from domestic and dating abuse and reduce discriminatory practices, such as chokeholds, among law enforcement officers and agencies.

Additional challenges lie ahead in the new year. ACP will support all of these measures and is supportive of Congress expanding patient access to health care by creating a public option and equalizing reimbursement to primary care physicians for services rendered to Medicare and Medicaid patients. Currently, Medicaid reimbursement lags behind that for services rendered to Medicare patients for primary care. We hope that when Congress has the Build Back Better Act in our rearview mirror, it can turn its attention to other critical issues, such as reforming the Medicare Access and CHIP Reauthorization Act (MACRA) and improving the Medicare payment system. ACP asked Congress to hold hearings last year and is doing so again this year. Just as the salmon swims upstream as part of its annual passage, we will see what currents we encounter in 2022 as we encourage Congress to consider these issues more fully, ensuring that Medicare payment cuts do not threaten us again during Congress' annual rite of passage.