Cherry Blossoms and Government Shutdowns

It is Cherry Blossom Week in the nation’s capital. Unfortunately, we’re coming off warm days last week, and the weather is starting to chill a bit.

The political forecast in D.C. this week looks similar. Although it seemed like the House of Representatives was going to decide on a final 2024 appropriations package this past Sunday, it didn’t happen.

That’s right: it’s springtime in D.C., which means, once again, there is a government shutdown looming. Once again, as of this morning, Congress has not agreed on a budget package.

To review, this is the 2024 budget that Congress managed to postpone at the end of last year until February, and then it was postponed again until this month, March. Earlier this month, they passed yet another continuing resolution that gave them until this Friday to pass six remaining appropriations packages covering 70 percent of federal agencies.

Congress had planned to unveil the final budget this past weekend, so lawmakers would have the time to read it, because House rules give lawmakers 72 hours to read any bill before voting.

However, talks broke down on Sunday, mainly about budgeting for the border. Late Sunday night, talks started back up, and the House is still aiming to get the package introduced. If it’s introduced on a Monday, the House can vote on a Thursday, and the hope is that the Senate passes the law by Friday, which is Congress’s most recent self-imposed deadline.

Otherwise, expect another continuing resolution to buy more time.

A note here: the 3.4-percent Medicare physician reimbursement cuts is not at issue in this most recent package. A bill was already passed in early March that provided somewhat of a fix to that issue. In that earlier bill, lawmakers reduced the total from a 3.4-percent cut to about a 1.7-percent cut. If you subtract that from an earlier increase from the end of last year, physicians are looking at about a half-percent cut overall.  

To take a step back, these yearly physician reimbursement cuts are put in place by regulations published every year by the Centers for Medicare & Medicaid Services (CMS) on the Physician Fee Schedule (PFS). The PFS is driven by the requirement that Medicare spending be budget-neutral; that is, the budget cannot increase by more than $20 million in any given year. In response, Congress has enacted one-year increases to counter CMS’s cuts every year for the past four years.

Overall, it’s a pretty inefficient system. However, there is a push in Congress this year to reform the whole Medicare physician reimbursement process, so let’s talk a bit about any reform’s chance of success.

First, this might be a good year to tackle provider reimbursement reform, because it’s an election year.  In general, not a lot of legislation gets passed in Congress during an election year, so in a sense, lawmakers have more time to focus on big, complicated issues like this. Also, both sides of the aisle agree that the current system is inefficient, and that’s rare enough, and you also have many lawmakers in Congress who are also doctors, so there’s some sympathy there.

On the other hand, reform may not be possible this year, first, because it is an election year. Even if lawmakers on both sides of the aisle agree on an issue, it’s a bad year to give the perception that you agree with the other side. Rhetoric and hyperbole are the specials on the menu during election years, so while there may be time to work on reform, there may not be much in the way of will.

But let’s get through the impending shutdown this week and then we’ll see about any long-term reform.

A quick review: Congress has passed continuing resolutions five times since last September. Each time, these continuing resolutions have allowed them to postpone making a decision on the budget.

Lesson learned: next time your spouse or boss wants something done, give yourself a few extra months by telling them you’ve passed a continuing resolution.