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What is House Bill H.R. 2?

This bill would reform Medicare’s Sustainable Growth Rate (SGR), a formula used to determine physician reimbursement. The bill would extend the Children’s Health Insurance Program (CHIP) by two years, while implementing other changes to Medicare and related health programs.

The SGR was established in 1997 to set the Medicare payment rates for physicians. It was designed to ensure that the spending per beneficiary for physician services would "grow on average at the rate of increase in gross domestic product per capita minus the expected rate of increase in productivity for the economy as a whole."

This bill would repeal the current SGR that is currently scheduled to reduce physician compensation by 21 percent on April 1, 2015. The SGR would be replaced with plan to give physicians a 0.5 percent annual pay increase through 2019. After that, doctors would operate in a system that either grants them bonuses or penalties based on their government performance scores.

Funding for CHIP would be extended until 2017, as it would currently run out of money after the 2015 fiscal year despite the program being authorized through 2019. If you don't know, CHIP is a program offering low-cost health coverage to children from families that earn too much money to qualify for Medicaid. It is offered in every state and as of 2013, covers more than eight million children and pregnant women.

This bill also authorizes another two years of funding into 2017 for the Community Health Center (CHC) Program, that is otherwise set to expire in September 2015. In 2013 the CHC served 22.7 million patients across 9,518 sites.

Impact

Patients enrolled in Medicare and/or CHIP, physicians providing services through Medicare and/or CHIP, the Department of Health and Human Services (HHS), the Secretary of HHS.

Cost of House Bill H.R. 2

$141.00 Billion

A CBO estimate found that enacting this bill would increase both direct spending (by about $145 billion) and revenues (by about $4 billion) — resulting in a $141 billion increase in federal budget deficits.

More Information

Of Note: Congress has been forced to pass 17 of these so-called “Doc Fix” bills in the last 11 years, with many ready for a long-term solution to be put in place. While this legislation does have bipartisan support in both chambers of Congress, it has been met with concerns from both sides of the aisle as well.

Some House Republicans are concerned that Speaker Boehner will be unable to rally a majority of his members to support the legislation, while Senate Democrats are said to favor a four-year extension of CHIP — which is longer than what this legislation currently offers. House Democratic whip Steny Hoyer (D-MD) noted that while he’d prefer a four-year extension of CHIP, “the issue is between zero and two [years]. And two is better than zero."

Other provisions of this bill: This bill would extend specific Medicare programs, including those for Medicare-dependent hospitals, Medicare Advantage plans for special needs individuals, and funding outreach regarding low-income programs - among others.

The qualifying individual (QI) program would be permanently extended — allowing it to assist low income individuals in covering the cost of their Medicare Part B premium. The transitional medical assistance (TMA) program — helping families covered by Medicaid to maintain their coverage for up to one year as they transition from welfare to work — would also be extended permanently.

Programs for Native Americans with Type I and Type II Diabetes would be extended through 2017. Also extended through 2017 would be abstinence only programs and the personal responsibility education program (PREP) which allows states, tribes, and other local agencies to implement strategies for youth development, adulthood preparation, and preventing teen pregnancy and STD transmission.

Beginning in 2020, new enrollees to Medicare's supplement insurance, Medigap would only receive first-dollar coverage (i.e. the plan pays both deductibles and copayments) after the amount of the Medicare Part B deductible (which is currently $147 per month).

Income-related premium adjustments for Parts B and D would increase the percentage that Medicare beneficiaries with incomes between $133,501 and $160,000 as individuals (or $267,001 - $320,000 as a couple) from 50 percent to 65 percent. Beneficiaries that have incomes at or above $160,001 or ($320,001 as a couple) would pay 80 percent of their premium. These thresholds would be updated based on inflation beginning in 2018.

Media:

Summary by Eric Revell

(Photo Credit: Flickr user darkensiva)

AKA

Medicare Access and CHIP Reauthorization Act of 2015

Official Title

To amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children's Health Insurance Program, and for other purposes.

bill Progress

EnactedApril 16th, 2015
The President signed this bill into law
The senate Passed April 15th, 2015
Roll Call Vote 92 Yea / 8 Nay
The house Passed March 26th, 2015
Roll Call Vote 392 Yea / 37 Nay
IntroducedMarch 24th, 2015