[Congressional Record Volume 170, Number 9 (Wednesday, January 17, 2024)]
[House]
[Pages H182-H185]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1815
ASSESSING IMPACT OF MEDICARE CUTS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 9, 2023, the Chair recognizes the gentleman from North Carolina
(Mr. Murphy) for 30 minutes.
General Leave
Mr. MURPHY. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
include extraneous material.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from North Carolina?
There was no objection.
Mr. MURPHY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, in 1965, a program called Medicare was incepted. It was
offering health benefits to those over age 65.
At first, physicians were very suspicious of allowing so much
government intervention in medicine. After a while, more and more
physicians doing their duty to take care of patients accepted it.
The sad fact and the problem is that Medicare now is what they, in
1965, were very afraid of, that so much of government has gotten into
medical issues.
This is the main problem. Medicare does not reimburse the cost of
care for patients. This is a real access issue. We are not really
talking about paying physicians. We are talking about access to care.
This year, CMS is proposing a 3.37 percent cut to the physician fee
schedule. It would be about a 20 percent cut over the last 20 years.
Doctors want to see Medicare patients, but they simply won't be able
to, and this is going to affect access to care.
Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Joyce),
my good friend who is board-certified in internal medicine and
dermatology.
Mr. JOYCE of Pennsylvania. Mr. Speaker, I thank the gentleman for
yielding and for holding this Special Order to discuss the issues of
the impact of the Medicare cuts.
In rural communities, like where I serve in south central and
southwestern Pennsylvania, seniors rely on Medicare to see their
doctors, to fill their prescriptions, and to take an ambulance in case
of an emergency. Now, these patients are in serious danger of losing
access to their trusted healthcare providers.
Medicare pay cuts, when compiled with 4.6 percent medical inflation,
result in increased barriers to care for Medicare beneficiaries.
Let's be clear about what these cuts mean for a Medicare patient, and
these cuts, for everyone's information, have already gone into effect
on January 1.
These cuts mean that rural and small providers will be forced to
restrict access to Medicare patients and, in dire cases, will be unable
to keep their doors open at all.
As a doctor, I understand firsthand the negative impact that these
significant year-after-year cuts have on rural providers.
Now, extrapolate that and then compound that with already existing
workforce shortages in underserved areas like my district in rural
Pennsylvania. I can assure you the repercussions are dire. These cuts
jeopardize physicians' ability to provide quality care for elderly
patients in our communities.
When physicians who participate in Medicare are increasingly being
forced to do more with less, it is ultimately the patient who will
suffer. These cuts will accelerate practice consolidation and force
patients into higher cost settings for care. It will mean longer travel
times and longer wait times for patients to see their family doctor, to
see a surgeon, and to see a specialist.
As physicians and as legislators, we have an obligation to work to
find a solution for Medicare patients. Congress must step in and
address these cuts before they do any additional damage to our
healthcare system.
Mr. Speaker, I thank the gentleman for holding this Special Order
hour.
Mr. MURPHY. Mr. Speaker, I yield to the gentleman from Texas (Mr.
Burgess), one of the doctor co-chairs. He has been a stalwart in the
Chamber for 20-plus years as a physician, a retired OB-GYN.
Mr. BURGESS. Mr. Speaker, I thank Mr. Murphy for bringing us together
tonight. I am here tonight not just because I am a Member of Congress
from the 26th Congressional District, but I am also a doc. I practiced
for 25 years back home. I am a Medicare patient. I know firsthand how
hard it can be to find a doctor that still accepts Medicare.
I will tell you, there is nothing more injurious to our medical
system here in this country than the repetitive cuts that this
administration has delivered to the doctors of this country.
In November, the Centers for Medicare and Medicaid Services finalized
a 3.5 percent cut in physician payments for this year, 2024, a decision
that took place on January 1 of this year, a blow to the very backbone
of our healthcare.
As a member of the Energy and Commerce Committee, we had an actual
historic event last month. We marked up a doc fix and a budget
neutrality bill.
The GOP Doctors Caucus and the Energy and Commerce Committee took
action to address the challenges by passing H.R. 6545, which was the
Physician Fee Schedule Update and Improvements Act. That bill includes
a conversion factor update as well as provisions
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from H.R. 6371, the Provider Reimbursement Stability Act, also led by
the GOP Doctors Caucus.
These provisions make needed changes to the budget neutrality
requirement, allowing for long-term sustainability within the physician
fee schedule. These are significant steps, and the urgency cannot be
overstated.
On January 1, those lower rates went into effect. CMS has said they
are going to hold payments until Congress acts, but if we don't act
pretty darn quick, they will have to remit at the lower level. The
doctors can never go back and recoup the money that they should have
been paid.
This is a crisis that is not necessary. We can fix this. We can fix
this in the CR. Unfortunately, congressional Democrats, the minority
leader on the House side, and the Finance Committee chairman on the
Senate side are blocking this very simple fix from occurring. It is
wrong. It needs to change.
Mr. Speaker, I thank the gentleman for holding this Special Order
hour.
Mr. MURPHY. Mr. Speaker, it is about access. Physicians want to see
Medicare patients, but if you do not pay the bills, they can't keep the
doors open.
Mr. Speaker, I yield to the gentleman from Ohio (Mr. Wenstrup), my
good friend and a board-certified podiatric surgeon.
Mr. WENSTRUP. Mr. Speaker, America and Members of Congress really
need to understand the impact these recent cuts to the Medicare
physician fee schedule have on patient access to healthcare across the
country.
The cuts that took place January 1, 2024, took effect, impacting
providers everywhere. Providers have to continue to bear the costs and
the many challenges that arose during and after the pandemic, including
staffing shortages, supply chain shortages, and continued rising
inflation. As the cost of providing care continues to rise, the
reimbursement to physicians who provide that care continues to be cut.
We can't keep this up.
Here is the scary part. Doctors retire early. Some reduce Medicare
patients out of survival for their practice or stop seeing them at all,
and they hate that. They quit taking call. They go to a cash-only
practice in order to keep their doors open.
If we don't act swiftly to address these cuts now and in the long
term, patients are going to suffer the most. The physician shortage
will continue to rise. Hospitals and independent community-based
providers will continue to shut their doors. America's seniors will be
left with no option for high-quality, affordable healthcare. Rural
communities in underserved areas will become healthcare deserts.
Mr. Speaker, I urge congressional leadership to put the health of
America first. Ensure that patients and Medicare beneficiaries have
access to the providers who care for them.
We have to stop these cuts. Every cut the government makes affects
the entire United States. We are one great Nation, but we become a less
healthy Nation.
This is just one issue that gets in the way of our goal to make the
United States of America the healthiest nation on this planet.
Mr. MURPHY. Mr. Speaker, we are experiencing a doctor shortage, and
it is going to get worse and worse, driving physicians out because they
no longer are able to be paid for their services or forcing them into
employment that destroys the historically great quality of medicine in
America.
Mr. Speaker, I yield to the gentleman from California (Mr. Panetta),
my good friend from the Ways and Means Committee.
Mr. PANETTA. Mr. Speaker, I rise today to talk about a very pressing
issue that not only have we heard about throughout our country but
especially in the 19th Congressional District of California, which I
represent. It is the decreasing amount of reimbursement rates to
Medicare providers. It is an issue, unfortunately, that threatens the
care for many senior citizens that I represent.
Now, as the proud Representative of California-19, it is a place
where the cost of living, unfortunately, can be pretty high--not just
for families, not just for workers, but for doctors, as well.
We in the 19th are already facing challenges when it comes to keeping
enough medical providers around to care for our seniors. It is actually
a problem throughout California where not only is the cost of living
too high, but also Medicare reimbursements are way too low.
Mr. Speaker, 76 percent of California physicians report that Medicare
no longer covers their cost to provide care. That puts more than 6.5
million Californians enrolled in Medicare at risk as many primary care
doctors are not even taking new part B patients.
A key driver of this is how Medicare isn't reimbursing physicians
enough. This past year, Medicare expenses rose 4.6 percent. In the past
two decades, payments to providers have declined 26 percent while costs
to providers have risen 47 percent, according to the AMA.
What is worse is that when CMS updates payment rates for billing
codes under part B, that creates many unsustainable cuts for too many
providers and leads to way too many scheduled decreases to Medicare
physician reimbursement.
Because of that, we are seeing physicians take on fewer Medicare
patients, and we all know what that means--that there are more seniors
with fewer healthcare options.
Now, fortunately, thanks to the leadership of Mr. Murphy and other
Members of Congress who have come together in a bipartisan fashion for
a temporary fix, this legislation would provide an offset for the cuts
to providers so that our providers keep getting reimbursed
appropriately, so that we can keep providers in our communities, and so
that providers can keep serving the needs of seniors.
I am proud to work with Representative Murphy on the Ways and Means
Committee for this straightforward fix to this problem, but this
Congress needs to act with urgency, as these cuts have already taken
effect.
Ultimately, we need a long-term solution to this issue by ensuring
that Medicare reimbursement is keeping up with inflation and that the
system is streamlined so physicians can continue to care for their
patients.
We can't underestimate how Medicare plays an essential role in the
health of senior citizens. That is why Congress must ensure that in
order for it to continue to be that cornerstone of healthcare, we must
provide our providers with the proper reimbursement so that our seniors
can get proper healthcare.
I appreciate Mr. Murphy's leadership on this, and I look forward to
working with many of our colleagues on both sides of the aisle to do
our job by making sure the Federal Government works for our
constituents by ensuring that Medicare always allows our providers to
care for our senior citizens.
Mr. MURPHY. Mr. Speaker, as you can see, this is obviously a
bipartisan issue. We care about our constituents, but we also care
about the health of our constituents.
Mr. Speaker, 10,000 Americans each day are added to the Medicare
rolls. Again, with such a doctor shortage, you are adding more and more
individuals where Medicare doesn't pay their bills, and it is harder
and harder to take care of them.
Mr. Speaker, I yield to the gentleman from California (Mr. Bera),
another physician friend of mine from the great State of California, to
discuss the difficult problem we are facing today.
{time} 1830
Mr. BERA. Mr. Speaker, over 30 years ago I graduated from medical
school. As you are kind of figuring out what you want to do as a
resident, I chose to become a primary care internal medicine doctor.
The rationale for that decision was to take care of our seniors: Our
moms, dads, grandparents, and so forth.
I love the job. You put that white coat on, you are there and able to
help people immediately. That is the joy of being a doctor.
When I talk to my colleagues today, the practice of medicine has
gotten harder and harder: The administrative burdens, the lack of
reimbursement, the cost of care, the amount of physician burnout.
That is not why we went to medical school. That is not why we went
into this profession.
We went into the profession to take care of folks, but if you can't
cover your expenses, if you can't give the necessary care to those
individual patients, to our parents and grandparents, then it becomes
hard. It becomes challenging. We have to fix this.
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We have to at least make sure the cost of care, what we give our
providers, our doctors, keeps pace with inflation. You see it in every
other aspect of healthcare, yet, physician reimbursement is going in
the wrong direction.
Mr. Speaker, all we are asking for is to keep up with the pace of
inflation and allow our doctors, America's doctors, to take care of our
senior citizens. These are folks that have worked their entire life.
They have paid into Medicare. They just want routine care.
So let's do what is right. Let's fix this. Let's do a temporary fix
in this Congress.
We can do it. We have a few weeks left to get that done, then let's
actually come together as Democrats and Republicans, take a look at it,
come up with new ideas so there is predictability so that America's
seniors and America's doctors can take care of our patients.
Mr. Speaker, I thank the gentleman, Dr. Murphy, for his leadership.
Mr. MURPHY. Mr. Speaker, the gentleman points out a perfect issue. We
are depriving access to patients and developing more and more concierge
medicine, which is wonderful for those who can afford it, but for those
who can't afford to go and see one of these cash doctors, and you can't
get into a doctor's office because they can't take more Medicare
patients, guess what happens? They get driven to emergency departments
where a more costly care goes on.
We have to stop this nonsense.
Mr. Speaker, I yield to the gentlewoman from Washington (Ms.
Schrier), a pediatrician.
Ms. SCHRIER. Mr. Speaker, I rise today to speak about fair physician
reimbursement to urge my colleagues to immediately address the
physician fee schedule cuts that went into effect on January 1, and in
a broader sense, address chronically lagging Medicare physician care
reimbursement.
Fundamentally, fair reimbursement respects the work that physicians
do, and it keeps those physicians' practices open and available to
patients so that seniors and others can get the care they need.
Over the past 22 years, adjusting for inflation, physicians have
essentially taken a 26 percent pay cut from Medicare. This is in the
context of everything else increasing, with expenses up about 47
percent.
I cannot think of another profession whose compensation has dropped
by 26 percent over two decades.
If we continue down this path, we will soon find ourselves with loved
ones or ourselves unable to find a physician because physician offices
will close.
Because of CMS rules, on January 1, physicians just took a 3.4
percent cut in Medicare reimbursement. The least we can do is reverse
that.
Last month, I co-led a letter with my colleagues encouraging a fix to
this. Here is a way to do it: I co-led a bill that passed out of the
Committee on Energy and Commerce that would level physician
reimbursement from Medicare and keep it essentially unchanged this
year.
Physicians are nervous, and, fundamentally, we need a longer term
solution, and that means we need Medicare reimbursement to keep pace
with inflation.
That is how we will keep these practices open. We are already seeing
practices in rural communities and small towns closing their doors or
being consolidated.
Without adequate reimbursement, we are going to see more of this,
offices closing, and that will result in patients, seniors, and others
who require or depend on Medicare not being able to access the high-
quality care they need.
Mr. MURPHY. Mr. Speaker, if you owned a hardware store and sold
hammers that cost $1 apiece but you had to sell them for 40 cents
apiece, how long would you sell hammers?
You wouldn't sell them very long because it just doesn't make
financial sense, and you literally can't just give money and walk money
out the door.
Unfortunately, this is what is happening with Medicare patients.
Physicians want to take care of their patients. They are caring
individuals, but when the numbers don't matter, you just can't do it.
Mr. Speaker, I yield to the gentleman from Georgia (Mr. McCormick),
and emergency room physician, to talk on this issue.
Mr. McCORMICK. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, it is rare in this Chamber, especially recently, that
you find a bipartisan effort, especially one that is all about the
people. In this case, it is about the people.
You have seen several physicians and several people from different
committees from all over the Nation agree on one thing: We are not
doing the right thing.
By cutting Medicare payments to individual practitioners, we have
done the opposite of the right thing. We will consolidate healthcare.
You lose the cheapest way to deliver healthcare to the most people.
Right now, hospital systems employ 71 percent of all physicians, and
that is going up every year.
Physicians deliver healthcare at the lowest possible rate. That is a
fact. By doing the Medicaid payment cuts just to physicians, not to
hospital systems, just to physicians at this quantity, you are forcing
more physicians to work for hospitals, which means less competition and
higher prices. That is the end-all be-all to what is going to happen
right now.
It is not going to save more money. It is going to mean more
consolidations, more monopolistic practices, higher prices, and worse
access, because physicians simply won't be out there to accept you as
patients.
You will have people retire; you will have people go out of business.
When those physicians aren't there to take care of you at the most
rudimentary level, the best and more affordable level, you will have
nothing but worse patient care and a worse environment for physicians.
Therefore, I do recommend, just like my colleagues on both sides of
the aisle, to do the right thing. If people in Congress on both sides
of the aisle are demanding to do the right thing, why can't we make it
happen?
Mr. Speaker, I encourage all of us to stand with our fellow
physicians in a bipartisan effort to pass legislation to prevent cuts
to the Medicare payments to physicians.
Mr. MURPHY. Mr. Speaker, may I inquire how much time I have
remaining?
The SPEAKER pro tempore. The gentleman has 9 minutes remaining.
Mr. MURPHY. Mr. Speaker, I have seen Medicare patients for more than
30 years. I have had individuals come in my office after I have
operated on and cared for them in the hospital and apologized, flat out
apologized for the lack of payment that we received from Medicare.
I tell them I do it because I love operating and taking care of
people, but there comes a point where you have to keep the lights on,
you have to pay your nurses, and pay your mortgage.
Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs.
Harshbarger), a doctor of pharmacy, to talk about the ridiculous cuts
that are facing our colleagues as physicians.
Mrs. HARSHBARGER. Mr. Speaker, I rise today to address the rising
cost of healthcare due to inflation and the need to address Medicare
physician payments to ensure quality care for our seniors.
Adjusting for inflation and practice costs, Medicare physician pay
has declined over 25 percent since 2001.
Despite this important statistic, Medicare payment updates are
scheduled for all healthcare providers except physicians in 2024.
Last November, CMS finalized a rule that would decrease Medicare
reimbursement for physician services by 3.37 percent this year.
Combined with 3 years of consecutive cuts to Medicare and the rising
practice costs, Medicare payments have been cut by nearly 10 percent.
Mr. Speaker, what physician will continue to practice when their
salaries are being cut by 10 percent?
It is critical that Congress takes action to address these
unsustainable Medicare cuts immediately in order to ensure that
patients continue receiving quality care.
The negative effects of these cuts will hit our seniors living in
rural areas the hardest; areas that already face significant healthcare
challenges.
As a community pharmacist in one of the country's most rural
districts and co-chair of the Rural Healthcare Caucus, I urge the House
and Senate to act
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swiftly on passing legislation that would stabilize Medicare payments
to physicians and other providers to ensure that our seniors maintain
access to quality healthcare.
Mr. MURPHY. Mr. Speaker, we submitted a bill, H.R. 6683, a couple
weeks ago, and while ENC was able to keep the cut at 1.25 percent, we
are actually desiring to not allow the cut at all. We are taking money
from the Medicare Improvement Fund, which is what the money is for, to
solve problems within Medicare.
Unfortunately, as this was a wonderful bipartisan discussion this
evening, we are oftentimes imprisoned, if you will, sometimes to the
will of some of the leaders over in Senate, sometimes even here in the
House.
Leaders over in the Senate didn't want anything for a doctor fix. The
Democratic leader said, no, we want this huge wish list of things done,
and we will trade that for the doctor fix.
Well, guys, you can't take poison pills to try to help physicians.
This is where there should not be politics whatsoever. We saw both
sides tonight, Democrats and Republicans, speak about the healthcare of
patients in this country.
Mr. Speaker, at some point it is going to snap. At some point,
whether it be what Obamacare was trying to do, absolutely starve
private practice so that everybody would either be bought out by
private equity or have to be assumed by hospital systems. Where, by the
way, physicians don't work as efficiently, physicians cost more, and
they see fewer patients. It is a closer ownership care of patients.
When I was practicing full-time, if another doctor called me and
said, hey, can you see somebody? My response was always: Do you want me
to see them today or tomorrow?
The sad fact is once physicians become employed, not only do they
cost more to the system, but the work ethic is not as good. That is
just point-blank what is seen.
What we need to understand is that private practice is the most
efficient way of delivering healthcare in this country, but it is also
the one where we care the most, and we follow up. We are always happy
to see that next patient and make sure that we keep our doors open.
At this point, Mr. Speaker, we are going to approach a calamitous
cliff, if you will, in the next 3 to 5 years with the number of
surgeons that are available to take care of patients.
I am a urologist. I take care of disorders of the kidney, prostate,
and bladder--those type of things. We are the most critically short
specialty in the country.
Right now, the median age of individuals practicing urology is my
age, the age of 60. If now we are not paying doctors enough to stay in
business, they are going to quit. We are going to make a bad shortage
even worse. We have to pay those who take care of patients what they
need to be paid.
Mr. Speaker, I appreciate that this was a bipartisan discussion this
evening, something that is easy for our leadership to fix. I ask that
they do that.
Mr. Speaker, I yield back the balance of my time.
____________________