NCHC Gives 113th Congress A Failing Grade On Health Care Cost Control...So Far

It is no secret that the 113th Congress has had little success reaching agreement on major policy changes, so its lackluster results on a report card from The National Coalition on Health Care (NCHC), grading lawmakers in the health care arena, should come as little surprise.

NCHC even graded on a curve by looking only at three areas where it initially saw promising prospects for bipartisan cooperation: modernizing physician payments/repealing the Sustainable Growth Rate (SGR) formula, increasing price and quality transparency, and strengthening Medicare by making it more efficient. NCHC handed out a D+ for strengthening Medicare, failed Congress on transparency, and gave it an incomplete on SGR repeal and physician payment reform, subject to revision based on what happens in the lame duck session after the November elections.

SGR Repeal/Physician Payment Reform

Arguably the area with the most immediate prospects for action is permanent SGR repeal and replacement. As we discussed a few weeks ago, some lawmakers are targeting the lame duck session to repeal the SGR in order to capitalize on the progress they've made during this congressional session, even though the current "doc fix" does not expire until April. There is a bipartisan framework to replace the SGR with a system to encourage physicians to participate in alternative payment models, moving Medicare away from fee-for-service reimbursement. However, lawmakers have not agreed on offsets for the bill, which could cost between $150 billion and $200 billion over ten years. The partisan bills that saw the light of day were not encouraging.

NCHC gave lawmakers an incomplete on this category but said it would give them an F if there was no further action. We also will give them an F if they pass a permanent doc fix without legitimate offsets.

Quality and Price Transparency

The issue of transparency took center stage early in the congressional session when Steven Brill's Time magazine piece was published in early 2013. The article exposed the frequent lack of transparency in health care prices (and often highly inflated billing). Despite the attention the article received and the debate it helped ignite, Congress ultimately failed to pass legislation that dealt with transparency.

Although nothing passed Congress, lawmakers did not entirely ignore the issue. A bipartisan group of lawmakers in the House introduced a bill to require public posting of charges for hospital care and granting patients the right to know their out-of-pocket costs before receiving treatment. In addition, permanent SGR repeal bills in both chambers included reform of "qualified entities" -- nonprofit groups that are granted access to Medicare claims data -- to allow them to sell the data to providers, plans, and employers. Still, without concrete action, NCHC flunked Congress on transparency.

Strengthening Medicare

The only area where Congress received a (barely) passing grade was on strengthening Medicare by making it more efficient. Most of the major progress during the session came outside Congress in think tanks. NCHC pointed to reports by the Brookings Institution and the Bipartisan Policy Center on reforming Medicare fee-for-service as prominent examples of bipartisan coalescence around delivery system reforms. These reports showed promise for bipartisan cooperation on better care coordination within Medicare.

While Congress did not take any major steps in this session, it did take a step toward payment reform with the IMPACT Act, signed into law yesterday, which standardizes data reporting requirements for post-acute care providers and could show lawmakers where Medicare payments can be reduced or reformed. The report card also mentioned the ACO Improvement Act, which we blogged about recently, but noted that it was introduced late in the session and did not receive a hearing or a vote. In addition, the one-year doc fix enacted in March included legitimate savings and reforms to better align payments with costs. For these minor improvements, NCHC gave Congress a D+.


Congress could make this a productive session for health care if it produces a physician payment reform bill that is fully offset. That would both help move Medicare away from fee-for-service reimbursement and help make the program more sustainable. A one-two punch like that would turn around what so far has been a largely unproductive run for the 113th Congress.