Providing for Consideration of H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015, and Providing for Proceeding During the Period from March 27, 2015, through, April 10, 2015

Floor Speech

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Mr. BURGESS. Mr. Speaker, House Resolution 173 provides for
consideration of H.R. 2, the Medicare Access and CHIP Reauthorization
Act of 2015, under a closed rule, reflecting the careful, intricate,
bipartisan negotiations which brought this legislation to the floor.

The rule provides for 1 hour of debate, equally divided among the
chairs and ranking members of the Committees on Energy and Commerce and
Ways and Means.

As is customary, the rule allows the minority to offer a motion to
recommit on the bill.

Finally, the rule provides for the customary district work period
authority.

This bill, H.R. 2, resolves an issue that many of us have worked on
for our entire congressional careers.

This bill reflects years of bipartisan work, work across committees,
and even work across the Capitol with the other body. We brought
together Members of all ideological groups, as well as diverse outside
groups. We coalesced around a policy that will help patients, help
doctors, help providers to get out from under the constant threat of
payment cuts under the Medicare sustainable growth rate formula.

Everyone agrees that Medicare's sustainable growth formula has got to
go. Today, we are considering a bill to realistically accomplish that
goal.

The SGR formula was enacted as part of the Balanced Budget Act of
1997 in an attempt to restrain Federal spending in Medicare part B. We
now know that that is not working.

The SGR consists of expenditure targets which apply a growth rate
designed to bring spending in line.

Since 2002, the SGR formula has resulted in a reduction in physician
reimbursement rates. However, even though Congress has consistently
passed legislation to override the formula, these patches have resulted
in hundreds of billions of spent funds that could have gone to
improving the Medicare system.

If Congress were to let the formula continue, physicians would face a
21 percent reduction in reimbursement rates on April 1. The sustainable
growth rate's unrealistic assumptions of spending inefficiency have
plagued the healthcare profession and our Medicare beneficiaries for
over 13 years.

The bill before us repeals the sustainable growth rate formula,
avoiding potentially devastating across-the-board cuts slated to go
into effect next week. We do so at a cost lower than what Congress has
already spent or is likely to spend over the next 10 years. The
Congressional Budget Office has found that enacting H.R. 2 will cost
less than if we patched this formula over the next 10 years.

The bill before us today provides 5 years of payment transition. It
allows improved beneficiary access and allows medicine to concentrate
on moving to broad adoption of quality reporting and, most importantly,
allows Congress to move past the distraction of the SGR formula and to
begin identifying Medicare reforms that can further benefit our
citizens. This will also allow providers the time to develop and test
quality measures and clinical practice improvement activities, which
will be used for performance assessment during phase II.

During the stability period, physicians will receive annual increases
of one half of 1 percent. It seems small, but it is above what has been
provided over the past several years.

The quality measures are implemented in what is called the Merit-
Based Incentive Payment System. That will be evidence-based and
developed through a transparent process that values input from provider
groups. Quality reporting will measure providers against their peers
rather than a one-size-fits-all generic standard. Providers will also
self-determine their measures.

The bill consolidates three reporting programs into this incentive
payment system, easing administrative burdens and furthering the
congressionally established goals of quality, resource use, and
meaningful use.

This new reimbursement structure ensures continued access to high-
quality care while providing physicians with certainty and security in
their reimbursements. They will be aware of the benchmark they are
competing against and, unlike current law, all penalties assessed on
those not meeting the benchmark will go to those who do, keeping the
dollars in the Medicare system.

Provider standards will be developed by professional organizations in
conjunction with existing programs and will incorporate ongoing
feedback to physicians, further ensuring that optimal care is provided
to the patient.

Realtime feedback will be gained through registries and performance
data. Physicians will be encouraged to participate in the process
through data reporting. For eligible professionals who choose to opt
out of the fee-for-service program, alternative payment models will be
available.

These alternative payment models may include a patient-centered
medical home, whether they are in primary or specialty care, bundled
care, or episodes of care. Qualifying practices that move a significant
amount of their patients into these alternative payment models could
see a 5 percent quality bonus. By encouraging alternative payment
models and care coordination, this legislation will foster and
facilitate innovation.

It is important to note that while taking these important steps
toward ensuring quality care, the bill specifically states that these
quality measures are not creating a Federal right of action or a legal
standard of care.

Mr. Speaker, from beginning to end, this bill is about access: access
for our seniors, access for those who utilize the Nation's 9,000
community health centers, and, very importantly, the over 8 million
children who receive their care at some point during the year through
the Children's Health Insurance Program.

The bill also addresses health programs that have become known as
``extenders.'' Most are extended for 2 years under the bill. By
resolving the SGR, Congress will have the ability to commit itself to
working through these policies in the future.

The bill also puts into place important structural reforms to
Medicare that are the first steps toward starting the Medicare program
on a really long-term trajectory towards fiscal stability.

The bill is consistent in its themes throughout: payment stability;
reduce and streamline the administrative burden; increase predictability and
provider's interactions with the Centers for Medicare and Medicaid
Services; build transparency into systems; encourage innovation of
delivery of services; and keep providers in the driver's seat.

Most importantly, we provide access to care for our Nation's
patients.

America's providers agree:

``The American Osteopathic Association views this bipartisan
legislation as a clear and definitive approach toward comprehensive
reforms in our health care system for children, seniors, and our
Nation's physicians.''

Here is one from the American Academy of Family Physicians:
``This legislation is the result of bipartisan negotiations that have
produced legislative responses to some of our Nation's most pressing
health care issues.''

America's Essential Hospitals praised this bill, stating:

``This legislation represents the first truly bipartisan major health
care legislation in years. Please do not let this opportunity pass you
by--approve H.R. 2 as swiftly as possible.''

This is just a small sampling of the close to 800 organizations
spanning the political spectrum who have come together to endorse this
bill. From primary care, to specialists, to surgeons, to organized
nursing, our Nation's hospitals, and everyone in between, they have
supported this policy.

For that reason, I encourage my colleagues to vote ``yes'' on the
rule and ``yes'' on the underlying bills.

I reserve the balance of my time.

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Today's rule provides for the consideration of legislation addressing
the pernicious sustainable growth rate formula, the most threatening
issue in Medicare, risking patient access to care for our seniors.

As I close, I would like to note that each committee's work is
represented in H.R. 2. The base policy of H.R. 2 has the backing of the
House and Senate negotiators and of all three committees of
jurisdiction.

I certainly want to thank the Speaker and the minority leader and
their staffs for building off of the policy work accomplished by the
committees to present a political pathway forward for this bipartisan
bill.

I thank the chairmen and ranking members of the House Committees on
Energy and Commerce and Ways and Means, as well as of the Senate
Finance Committee, for coming together for our Nation's doctors and
seniors.

I must note Chairman Upton, Chairman Pitts, Chairman Ryan, Chairman
Brady, and former Chairman Camp, as well as Ranking Members Pallone,
Gene Green, Sander Levin, Jim McDermott, and former Ranking Member
Henry Waxman.

I would also like to thank all of the staffs who have worked on this
issue--who have labored on this issue--for years. I know I will miss
some people, but I do want to mention a few at the committee level who
have dedicated themselves to getting us here today.

Some have left or switched their roles, but their work from the
beginning deserves recognition. Certainly I want to thank Clay Alspach,
Robert Horne, Ryan Long, Dr. John O'Shea, Dr. Steve Ferrara, Amy Hall,
Eddie Garcia, Tiffany Guarascio, Arielle Woronoff, Brett Baker, Brian
Sutter, Matt Hoffmann, Erin Richardson, and J. P. Paluskiewicz on my
staff.

I also want to thank the unsung heroes at the House Legislative
Counsel, namely, Jessica Shapiro, Ed Grossman, and Jesse Cross.
Every success we have had at each point in this process was further
than we had ever come before, and that involved a lot of work, a lot of
negotiation, and a lot of overwhelming desire to see the process
through to the end.

Ultimately, if this is a package that can go to the White House, all
of this will be worth it. I certainly do look forward to passage and
hope that, given the positive signs evidenced over the past several
days, the other Chamber will quickly embrace this package and
ultimately get this badly needed policy into law.

I certainly want my colleagues to support both the rule and the
underlying bill.

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