Dec. 17, 2021 (ACP) – As the end of the year fast approaches, unresolved matters in Congress include a final appropriations spending bill, the massive Build Back Better Act and a crucial bill to improve the mental health and well-being of physicians.
“Congress is juggling many balls at once, and its decisions will be crucial to physicians and patients,” said George Lyons Jr., Esq., ACP director of legislative affairs. “We're working with other top medical organizations and enlisting our membership to make sure our representatives know our positions.”
While Congress averted several catastrophes at the last minute by sending the president several bills that allow the federal government to keep running through Feb. 18, 2022 and. to raise the debt ceiling—the amount of money that the nation can borrow. –until after the 2022 midterm elections, there is no timetable as to when the President's Build Back Better legislation might pass or if Congress can agree to a FY 2022 appropriations bill by Feb. 18.
If the debt ceiling was not raised, the government would not have been able to fully pay what it owes. Experts had warned that a default could have sent the world's economy into a tailspin.
On Dec. 7, Lyons said, “Congressional leadership reached a deal to raise the debt ceiling in a two-step process that would simply require a majority vote in both the House and Senate so that no Republicans would need to vote in favor of the measure in order to approve lifting the debt ceiling.”
The deal has been tied to the final passage of a bill that suspends Medicare physician payment cuts that are set to begin on Jan. 1, 2022. ACP had actively urged Congress to reverse Medicare cuts that combined would have slashed reimbursement by 9.75%. “These cuts would have come at a time when physician practices are still recovering from the financial effects of the COVID-19 public health emergency, including continued infection control protocols that have increased the costs of providing care,” Lyons said. “The combination of all these policies would be challenging to endure in normal times. Yet, physician practices continue to be stretched to their limits clinically, emotionally and financially as the pandemic persists well beyond 20 months. The enactment of further Medicare payment cuts would have threatened patient access to care. Moreover, when adjusted for inflation in practice costs, Medicare physician payments would actually have declined 22% from 2001 to 2020, or by 1.3% per year on average.”
According to Lyons, the debt ceiling deal will:
- Delay by three months (Jan. 1, 2022, to March 31, 2022) a 2% Medicare cut related to sequester rules.
- Delay by three months (April 1, 2022, to June 30, 2022) a 1% reduction in the Medicare sequester payment reductions.
- Provide a one-year increase (through Dec. 31, 2022) in the Medicare Physician Fee Schedule of 3% to address a budget neutrality conversion factor issue. This is a slight decrease from the 3.75% provided last year by Congress.
- Delay application of the 4% PAYGO cuts from 2022 to 2023.
- Delay for one year, though Dec. 31, 2022, Medicare payment reductions to the clinical laboratory fee schedule and the private laboratory data reporting requirements.
Meanwhile, ACP continues to support key provisions of the Build Back Better Act, although its future is uncertain in the Senate. “Republicans are challenging the bill's labor, immigration and prescription drug pricing provisions as being inconsistent with reconciliation,” Lyons said. Reconciliation refers to a process in which the Senate can pass certain legislation by a simple majority instead of a filibuster-proof super-majority.
As ACP told congressional leaders in November, the College supports critical components of the legislation because it “represents one of the largest investments in the modern era to strengthen the social safety net for millions of Americans who live and/or work in underserved communities disproportionately disadvantaged by societal and economic problems and the lingering effects of the COVID-19 pandemic. It examines social determinants of health care and seeks to address racial and economic disparities in access and quality of health care services, particularly for communities of color.”
The bill will also extend incentives and provide measures to combat climate change, improve the health care workforce, address eldercare assistance, extend permanently the Children's Health Insurance Program and improve upon maternal and behavioral health services while expanding coverage under the Patient Protection and Affordable Care Act.
Finally, ACP is standing behind the Dr. Lorna Breen Health Care Provider Protection Act, named for an emergency physician who died by suicide during the pandemic. “The legislation aims to prevent and reduce incidences of suicide, mental health conditions, substance use disorders and long-term stress, sometimes referred to as burnout,” Lyons said. “Through grants, education and awareness campaigns, the legislation will help reduce stigma and identify resources for health care clinicians seeking assistance. The bill also supports research on health care professional mental and behavioral health, including the effect of the COVID-19 pandemic.”
The legislation is “a timely opportunity to respond to the mental health needs of our nation's physicians,” Lyons said. “Mental health data show that physicians in the United States face higher incidents of suicide than almost any other profession.”
Lyons further remarked that, ACP expects this bipartisan legislation to pass at least one of the congressional houses this year on the way to full passage.
In terms of advocacy, “ACP is actively lobbying members of Congress and their staffs as well as jurisdictional committees to support provisions of the Build Back Better Act where we have policy,” Lyons said. “ACP worked with the American Medical Association and G-6 Coalition of six top medical organizations to support measures to prevent the Medicare pay cuts. The College has also launched a grassroots/Take Action campaign with its state chapters to support certain provisions of the Build Back Better Act, and ACP launched a similar campaign with the state chapters regarding the Medicare pay cuts.”