No reason to cheer fiscal cliff 'solution'
James M. Berklan, McKnight's Editor
Should a person be congratulated and backslapped for simply doing his or her job? That's the question that should be on people's minds today as they ponder what has happened with fiscal cliff negotiations.
On Monday, the Senate pushed through (by an overwhelming majority) a compromise measure. The embarrassed House Speaker, John Boehner (R-OH), went back to work Tuesday with his divided chamber, which ultimately decided to pass the Senate bill (257 to 167, with 85 Republican votes). Ultimately, both sides decided some deal was better than none, especially since the risk of another recession was in the air if nothing were changed. Thus, the House decided not to monkey around with amendments or the prospect of trying to pull Senators back in town for another vote.
Spared will be the nearly 30% Medicare physician payment cuts and, presumably, many other government program payment cuts. (The situation is fluid — many details simply are not clear at this point.) This could be good, if not great, news for providers.
Hospital lobbyists are complaining that they are taking the brunt of paying for the “doc fix” for the next 12 months. But therapy interests are heartened by the fact that their lobbying campaign paid off: The sweeping exceptions process to the Medicare Part B outpatient therapy caps is extended under the Senate plan. That will please many long-term care providers and residents.
However, the cheering should be muted. Some could fairly argue that these lawmakers weren't even doing what their jobs require. (See opening sentence above.)
The “fix” that the administration and Congress have agreed to was just another punt of the political football. Lawmakers and the White House passed the buck (but not the bucks) a little over a year ago to bring us to this week's logjam. That set up the fiscal cliff and the automatic sequestration cuts in the first place. That deal bought them about 12 months to try to figure out a (post-election) solution. Didn't happen.
Now, this latest “fix” buys negotiators about another two months. In other words, in just a few weeks this cycle will come up again. Republicans, who appear to have made the most concessions this time, figure they will have more leverage in about seven weeks, when debt-ceiling issues will rise back to the top. That's when the Treasury Department will have to find alternatives to expiring measures that have allowed the debt ceiling to rise to $16.4 trillion. The government risks not being able to pay its various bills unless the debt ceiling is raised.
Republicans are not likely to allow that to happen unless they get Democrats to agree to huge spending cuts. This is where it becomes especially dicey for providers again. In addition, by the end of March, a stop-gap measure that funds government agencies will expire. A renewal will be needed to avert a government shutdown.
Despite this week's progress, you have to wonder just what kind of threatened disaster or calamity will get our nation's political leaders to move in a unified decisive direction. Lately, there has been a lot of “If I can't get my way, I'm going to take my ball and go home” type of arguing in play. This is gamesmanship, not statesmanship and leaders from both sides of the aisle have acknowledged that more of the latter is needed.
The American public, including possibly you, have grown weary of this gambit. And rightly so. Because even if you, as a provider, have staved off cuts in the short-term, what happens down the road could be even uglier than what was feared this week. The same imperfections in the payment system remain, and the burdens of paying for an increasingly old and frail population will only escalate.