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Health Care Reform:

Health Insurance & Affordable Care Act

FAQ: New Exchanges Not for Seniors on Medicare

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Q: I've heard a lot about something called the Medicare "doc fix." What is that and does the health law fix it?

A: The "doc fix" refers to the sustainable growth rate, or SGR, which is the payment formula based on economic growth that Medicare has used to pay physicians since the late 1990s. Over the past decade, the formula would have cut Medicare physician payments but Congress has stopped the cuts. For example, it calls for a 25 percent drop next Jan. 1. Doctors warn that if the pay reductions were to take effect, fewer physicians will treat Medicare patients.

The health law does not change that formula, but there is bipartisan legislation pending on Capitol Hill that would. The House Energy and Commerce Committee passed a measure in July to repeal the SGR but the bill does not specify how to finance a fix.  The House Ways and Means Committee and the Senate Finance Committee are working on legislation as well.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Fri, Sep 20 2013

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