Doc Fix Deal

One of many definitions of the word “deal,” is an economic or social policy pursued by a political administration. There are New Deals, Square Deals, Fair Deals, and now, Doc Fix Deals.

The Senate has just passed a Doc Fix Deal by a vote of 92-8 to replace the old Sustainable Growth Rate (SGR) Deal, which has existed since 1997 but has been changed 18 times to prevent deep doctor cuts. This year, today, April 15, the cut was to be 21% for Medicare payments to doctors. This was unacceptable to doctors, who were likely to stop or reduce seeing Medicare patients, and besides, the cut might cause doctor shortages, which would alienate seniors,an important voting bloc, how entering Medicare at the rate of 10,000 a day..

Here is the essence of thedoc fix deal.

Medicare payments to doctors are to increase annually 0.5% through 2019, starting in July 2015.


After 2019, doctors will be paid by alternative.methods involving bundled bills, shared savings through Accountable Care Organizations, altered fee-for-service based on performance and outcomes, or some combination thereof.


The Childrens Health Insurance Program and Community Health Centers will be funded for two more years.


High income seniors will bear more of Medicare costs through co-payments for Medigap policies.

This is a bipartisan solution. Both sides tout the Doc Fix as a sensible solution to a complex problem. Republicans says it shows they can govern. Democrats say they got what they wanted- help for children and for the uninsured and poor who frequent Community Health Centers.

In the political health care arena, the next big deal will come with the Supreme Court decision in late June, If the Court rules in favor of federal health exchange subsidies, ObamaCare will go forward unimpeded. If the court rules negatively and Republicans are not ready with a simple, workable health care plan, it will be a make-or-break ObamaCare moment. Obama will ask Congress to pass a one-sentence bill allowing subsidies to flow through federal exchanges. He will mobilize his political operation and give heart-rending examples of subsidized patients who have been left high and dry without insurance.

Republicans are working on developing alternative bills which go under names like , “If You Like Your Health Care Plan, You Can Keep It Act,: and “Preserving Freedom and Choice in Healthcare,” but they have yet to unite behind a single bill. GOP Senator Ron Johnson of Wisconsin warns if Republicans wait until the ruling on King v. Burwell is handed down, it will be too late to derail ObamaCare (Ron Johnson, “ A Make-or-Break ObamaCare Moment,” Wall Street Journal, April 14, 201