With Congress returning next week for a contentious lame-duck session, doctors are stepping up their campaign to press lawmakers to put off major cuts in Medicare payments to physicians that are scheduled to take effect next month.
If Congress does not act, physicians who treat the elderly under the federal program will see a 23% cut in their fees starting Dec. 1.
But heading off the cuts has become an increasingly tortuous ritual on Capitol Hill, with lawmakers from both parties regularly scrambling to find a way to delay them, often at the last minute. When deferred, the cuts accumulate, which is why the pending reduction is so large.
In June, Democrats and Republicans reached a deal that postponed the cuts for six months. They made up the $6.5-billion price tag by making changes in pension law and some healthcare accounting rules.
The American Medical Assn., which for years has called for a permanent fix that would eliminate the need for annual action to put off the cuts, is now pushing for a 13-month extension.
"The cracks in the system are widening," Dr. Cecil B. Wilson, the AMA president, said Monday, warning that increasing numbers of doctors were being forced to scale back their care for Medicare beneficiaries.
Health and Human Services Secretary Kathleen Sebelius told a gathering of medical school leaders Monday that the Obama administration also backed a 13-month extension.
According to Sebelius, the president said at his Cabinet meeting last week that dealing with the cuts "must be one of our top priorities."
But Democratic leaders on Capitol Hill and in the administration are still trying to figure out how and when they will be able to address the looming cut, which could require as much as $15 billion over the next 13 months, the AMA said.
That promises to be doubly difficult during a lame-duck session that figures to be dominated by an intensely partisan debate over extending the George W. Bush-era tax cuts and passing a stopgap funding measure to keep the government operating into next year.