Skilled nursing providers and inpatient rehab facilities offer clashing views on Medicare payments

Both houses of Congress passed budgets late last week, setting up the next phase of the ongoing debate over healthcare spending.

The House of Representatives approved the budget created by Rep. Paul Ryan (R-WI) in a 221-207 vote last Thursday. The Senate passed the budget authored by Sen. Patty Murray (D-WA) in a 50-49 vote Saturday morning.

There is little hope the two budgets can be reconciled. They present very different plans, including in their proposals for the nation’s healthcare system. The Ryan budget would repeal the Affordable Care Act, create a Medicare voucher system and turn Medicaid into a block-grant program run mainly by the states. Ryan says this would save the federal government $2.5 trillion in healthcare costs over the next 10 years. The Senate Democrats’ budget includes some Medicare cuts, but would largely achieve an estimated $275 billion in reduced healthcare spending by building on Affordable Care Act programs meant to better coordinate care among acute, post-acute and other providers.

The budget debate is taking place as providers brace for a 2% reduction in Medicare payments set to take effect in April, due to the automatic spending cuts known as sequestration. The budget negotiations may be the best chance to restructure or eliminate those cuts, Speaker of the House John Boehner (R-OH) told reporters after the vote on the Ryan budget.

However, Boehner said he has not been in discussions with Senate leaders to set up a conference committee on the budgets, and Congress is currently on a two-week recess. If the budget negotiations do not succeed, the government will continue to be funded through temporary spending resolutions and specific appropriations bills.