[Congressional Record Volume 170, Number 9 (Wednesday, January 17, 2024)]
[House]
[Pages H182-H185]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1815
                   ASSESSING IMPACT OF MEDICARE CUTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 9, 2023, the Chair recognizes the gentleman from North Carolina 
(Mr. Murphy) for 30 minutes.


                             General Leave

  Mr. MURPHY. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from North Carolina?
  There was no objection.
  Mr. MURPHY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, in 1965, a program called Medicare was incepted. It was 
offering health benefits to those over age 65.
  At first, physicians were very suspicious of allowing so much 
government intervention in medicine. After a while, more and more 
physicians doing their duty to take care of patients accepted it.
  The sad fact and the problem is that Medicare now is what they, in 
1965, were very afraid of, that so much of government has gotten into 
medical issues.
  This is the main problem. Medicare does not reimburse the cost of 
care for patients. This is a real access issue. We are not really 
talking about paying physicians. We are talking about access to care.
  This year, CMS is proposing a 3.37 percent cut to the physician fee 
schedule. It would be about a 20 percent cut over the last 20 years.
  Doctors want to see Medicare patients, but they simply won't be able 
to, and this is going to affect access to care.
  Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr. Joyce), 
my good friend who is board-certified in internal medicine and 
dermatology.
  Mr. JOYCE of Pennsylvania. Mr. Speaker, I thank the gentleman for 
yielding and for holding this Special Order to discuss the issues of 
the impact of the Medicare cuts.
  In rural communities, like where I serve in south central and 
southwestern Pennsylvania, seniors rely on Medicare to see their 
doctors, to fill their prescriptions, and to take an ambulance in case 
of an emergency. Now, these patients are in serious danger of losing 
access to their trusted healthcare providers.
  Medicare pay cuts, when compiled with 4.6 percent medical inflation, 
result in increased barriers to care for Medicare beneficiaries.
  Let's be clear about what these cuts mean for a Medicare patient, and 
these cuts, for everyone's information, have already gone into effect 
on January 1.
  These cuts mean that rural and small providers will be forced to 
restrict access to Medicare patients and, in dire cases, will be unable 
to keep their doors open at all.
  As a doctor, I understand firsthand the negative impact that these 
significant year-after-year cuts have on rural providers.
  Now, extrapolate that and then compound that with already existing 
workforce shortages in underserved areas like my district in rural 
Pennsylvania. I can assure you the repercussions are dire. These cuts 
jeopardize physicians' ability to provide quality care for elderly 
patients in our communities.
  When physicians who participate in Medicare are increasingly being 
forced to do more with less, it is ultimately the patient who will 
suffer. These cuts will accelerate practice consolidation and force 
patients into higher cost settings for care. It will mean longer travel 
times and longer wait times for patients to see their family doctor, to 
see a surgeon, and to see a specialist.
  As physicians and as legislators, we have an obligation to work to 
find a solution for Medicare patients. Congress must step in and 
address these cuts before they do any additional damage to our 
healthcare system.
  Mr. Speaker, I thank the gentleman for holding this Special Order 
hour.
  Mr. MURPHY. Mr. Speaker, I yield to the gentleman from Texas (Mr. 
Burgess), one of the doctor co-chairs. He has been a stalwart in the 
Chamber for 20-plus years as a physician, a retired OB-GYN.
  Mr. BURGESS. Mr. Speaker, I thank Mr. Murphy for bringing us together 
tonight. I am here tonight not just because I am a Member of Congress 
from the 26th Congressional District, but I am also a doc. I practiced 
for 25 years back home. I am a Medicare patient. I know firsthand how 
hard it can be to find a doctor that still accepts Medicare.
  I will tell you, there is nothing more injurious to our medical 
system here in this country than the repetitive cuts that this 
administration has delivered to the doctors of this country.
  In November, the Centers for Medicare and Medicaid Services finalized 
a 3.5 percent cut in physician payments for this year, 2024, a decision 
that took place on January 1 of this year, a blow to the very backbone 
of our healthcare.
  As a member of the Energy and Commerce Committee, we had an actual 
historic event last month. We marked up a doc fix and a budget 
neutrality bill.
  The GOP Doctors Caucus and the Energy and Commerce Committee took 
action to address the challenges by passing H.R. 6545, which was the 
Physician Fee Schedule Update and Improvements Act. That bill includes 
a conversion factor update as well as provisions

[[Page H183]]

from H.R. 6371, the Provider Reimbursement Stability Act, also led by 
the GOP Doctors Caucus.
  These provisions make needed changes to the budget neutrality 
requirement, allowing for long-term sustainability within the physician 
fee schedule. These are significant steps, and the urgency cannot be 
overstated.
  On January 1, those lower rates went into effect. CMS has said they 
are going to hold payments until Congress acts, but if we don't act 
pretty darn quick, they will have to remit at the lower level. The 
doctors can never go back and recoup the money that they should have 
been paid.

  This is a crisis that is not necessary. We can fix this. We can fix 
this in the CR. Unfortunately, congressional Democrats, the minority 
leader on the House side, and the Finance Committee chairman on the 
Senate side are blocking this very simple fix from occurring. It is 
wrong. It needs to change.
  Mr. Speaker, I thank the gentleman for holding this Special Order 
hour.
  Mr. MURPHY. Mr. Speaker, it is about access. Physicians want to see 
Medicare patients, but if you do not pay the bills, they can't keep the 
doors open.
  Mr. Speaker, I yield to the gentleman from Ohio (Mr. Wenstrup), my 
good friend and a board-certified podiatric surgeon.
  Mr. WENSTRUP. Mr. Speaker, America and Members of Congress really 
need to understand the impact these recent cuts to the Medicare 
physician fee schedule have on patient access to healthcare across the 
country.
  The cuts that took place January 1, 2024, took effect, impacting 
providers everywhere. Providers have to continue to bear the costs and 
the many challenges that arose during and after the pandemic, including 
staffing shortages, supply chain shortages, and continued rising 
inflation. As the cost of providing care continues to rise, the 
reimbursement to physicians who provide that care continues to be cut. 
We can't keep this up.
  Here is the scary part. Doctors retire early. Some reduce Medicare 
patients out of survival for their practice or stop seeing them at all, 
and they hate that. They quit taking call. They go to a cash-only 
practice in order to keep their doors open.
  If we don't act swiftly to address these cuts now and in the long 
term, patients are going to suffer the most. The physician shortage 
will continue to rise. Hospitals and independent community-based 
providers will continue to shut their doors. America's seniors will be 
left with no option for high-quality, affordable healthcare. Rural 
communities in underserved areas will become healthcare deserts.
  Mr. Speaker, I urge congressional leadership to put the health of 
America first. Ensure that patients and Medicare beneficiaries have 
access to the providers who care for them.
  We have to stop these cuts. Every cut the government makes affects 
the entire United States. We are one great Nation, but we become a less 
healthy Nation.
  This is just one issue that gets in the way of our goal to make the 
United States of America the healthiest nation on this planet.
  Mr. MURPHY. Mr. Speaker, we are experiencing a doctor shortage, and 
it is going to get worse and worse, driving physicians out because they 
no longer are able to be paid for their services or forcing them into 
employment that destroys the historically great quality of medicine in 
America.
  Mr. Speaker, I yield to the gentleman from California (Mr. Panetta), 
my good friend from the Ways and Means Committee.
  Mr. PANETTA. Mr. Speaker, I rise today to talk about a very pressing 
issue that not only have we heard about throughout our country but 
especially in the 19th Congressional District of California, which I 
represent. It is the decreasing amount of reimbursement rates to 
Medicare providers. It is an issue, unfortunately, that threatens the 
care for many senior citizens that I represent.
  Now, as the proud Representative of California-19, it is a place 
where the cost of living, unfortunately, can be pretty high--not just 
for families, not just for workers, but for doctors, as well.
  We in the 19th are already facing challenges when it comes to keeping 
enough medical providers around to care for our seniors. It is actually 
a problem throughout California where not only is the cost of living 
too high, but also Medicare reimbursements are way too low.
  Mr. Speaker, 76 percent of California physicians report that Medicare 
no longer covers their cost to provide care. That puts more than 6.5 
million Californians enrolled in Medicare at risk as many primary care 
doctors are not even taking new part B patients.
  A key driver of this is how Medicare isn't reimbursing physicians 
enough. This past year, Medicare expenses rose 4.6 percent. In the past 
two decades, payments to providers have declined 26 percent while costs 
to providers have risen 47 percent, according to the AMA.
  What is worse is that when CMS updates payment rates for billing 
codes under part B, that creates many unsustainable cuts for too many 
providers and leads to way too many scheduled decreases to Medicare 
physician reimbursement.
  Because of that, we are seeing physicians take on fewer Medicare 
patients, and we all know what that means--that there are more seniors 
with fewer healthcare options.
  Now, fortunately, thanks to the leadership of Mr. Murphy and other 
Members of Congress who have come together in a bipartisan fashion for 
a temporary fix, this legislation would provide an offset for the cuts 
to providers so that our providers keep getting reimbursed 
appropriately, so that we can keep providers in our communities, and so 
that providers can keep serving the needs of seniors.
  I am proud to work with Representative Murphy on the Ways and Means 
Committee for this straightforward fix to this problem, but this 
Congress needs to act with urgency, as these cuts have already taken 
effect.
  Ultimately, we need a long-term solution to this issue by ensuring 
that Medicare reimbursement is keeping up with inflation and that the 
system is streamlined so physicians can continue to care for their 
patients.
  We can't underestimate how Medicare plays an essential role in the 
health of senior citizens. That is why Congress must ensure that in 
order for it to continue to be that cornerstone of healthcare, we must 
provide our providers with the proper reimbursement so that our seniors 
can get proper healthcare.
  I appreciate Mr. Murphy's leadership on this, and I look forward to 
working with many of our colleagues on both sides of the aisle to do 
our job by making sure the Federal Government works for our 
constituents by ensuring that Medicare always allows our providers to 
care for our senior citizens.
  Mr. MURPHY. Mr. Speaker, as you can see, this is obviously a 
bipartisan issue. We care about our constituents, but we also care 
about the health of our constituents.
  Mr. Speaker, 10,000 Americans each day are added to the Medicare 
rolls. Again, with such a doctor shortage, you are adding more and more 
individuals where Medicare doesn't pay their bills, and it is harder 
and harder to take care of them.
  Mr. Speaker, I yield to the gentleman from California (Mr. Bera), 
another physician friend of mine from the great State of California, to 
discuss the difficult problem we are facing today.

                              {time}  1830

  Mr. BERA. Mr. Speaker, over 30 years ago I graduated from medical 
school. As you are kind of figuring out what you want to do as a 
resident, I chose to become a primary care internal medicine doctor.
  The rationale for that decision was to take care of our seniors: Our 
moms, dads, grandparents, and so forth.
  I love the job. You put that white coat on, you are there and able to 
help people immediately. That is the joy of being a doctor.
  When I talk to my colleagues today, the practice of medicine has 
gotten harder and harder: The administrative burdens, the lack of 
reimbursement, the cost of care, the amount of physician burnout.
  That is not why we went to medical school. That is not why we went 
into this profession.
  We went into the profession to take care of folks, but if you can't 
cover your expenses, if you can't give the necessary care to those 
individual patients, to our parents and grandparents, then it becomes 
hard. It becomes challenging. We have to fix this.

[[Page H184]]

  We have to at least make sure the cost of care, what we give our 
providers, our doctors, keeps pace with inflation. You see it in every 
other aspect of healthcare, yet, physician reimbursement is going in 
the wrong direction.
  Mr. Speaker, all we are asking for is to keep up with the pace of 
inflation and allow our doctors, America's doctors, to take care of our 
senior citizens. These are folks that have worked their entire life. 
They have paid into Medicare. They just want routine care.
  So let's do what is right. Let's fix this. Let's do a temporary fix 
in this Congress.
  We can do it. We have a few weeks left to get that done, then let's 
actually come together as Democrats and Republicans, take a look at it, 
come up with new ideas so there is predictability so that America's 
seniors and America's doctors can take care of our patients.
  Mr. Speaker, I thank the gentleman, Dr. Murphy, for his leadership.
  Mr. MURPHY. Mr. Speaker, the gentleman points out a perfect issue. We 
are depriving access to patients and developing more and more concierge 
medicine, which is wonderful for those who can afford it, but for those 
who can't afford to go and see one of these cash doctors, and you can't 
get into a doctor's office because they can't take more Medicare 
patients, guess what happens? They get driven to emergency departments 
where a more costly care goes on.
  We have to stop this nonsense.
  Mr. Speaker, I yield to the gentlewoman from Washington (Ms. 
Schrier), a pediatrician.
  Ms. SCHRIER. Mr. Speaker, I rise today to speak about fair physician 
reimbursement to urge my colleagues to immediately address the 
physician fee schedule cuts that went into effect on January 1, and in 
a broader sense, address chronically lagging Medicare physician care 
reimbursement.
  Fundamentally, fair reimbursement respects the work that physicians 
do, and it keeps those physicians' practices open and available to 
patients so that seniors and others can get the care they need.
  Over the past 22 years, adjusting for inflation, physicians have 
essentially taken a 26 percent pay cut from Medicare. This is in the 
context of everything else increasing, with expenses up about 47 
percent.
  I cannot think of another profession whose compensation has dropped 
by 26 percent over two decades.
  If we continue down this path, we will soon find ourselves with loved 
ones or ourselves unable to find a physician because physician offices 
will close.
  Because of CMS rules, on January 1, physicians just took a 3.4 
percent cut in Medicare reimbursement. The least we can do is reverse 
that.
  Last month, I co-led a letter with my colleagues encouraging a fix to 
this. Here is a way to do it: I co-led a bill that passed out of the 
Committee on Energy and Commerce that would level physician 
reimbursement from Medicare and keep it essentially unchanged this 
year.
  Physicians are nervous, and, fundamentally, we need a longer term 
solution, and that means we need Medicare reimbursement to keep pace 
with inflation.
  That is how we will keep these practices open. We are already seeing 
practices in rural communities and small towns closing their doors or 
being consolidated.
  Without adequate reimbursement, we are going to see more of this, 
offices closing, and that will result in patients, seniors, and others 
who require or depend on Medicare not being able to access the high-
quality care they need.
  Mr. MURPHY. Mr. Speaker, if you owned a hardware store and sold 
hammers that cost $1 apiece but you had to sell them for 40 cents 
apiece, how long would you sell hammers?
  You wouldn't sell them very long because it just doesn't make 
financial sense, and you literally can't just give money and walk money 
out the door.
  Unfortunately, this is what is happening with Medicare patients. 
Physicians want to take care of their patients. They are caring 
individuals, but when the numbers don't matter, you just can't do it.
  Mr. Speaker, I yield to the gentleman from Georgia (Mr. McCormick), 
and emergency room physician, to talk on this issue.
  Mr. McCORMICK. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, it is rare in this Chamber, especially recently, that 
you find a bipartisan effort, especially one that is all about the 
people. In this case, it is about the people.
  You have seen several physicians and several people from different 
committees from all over the Nation agree on one thing: We are not 
doing the right thing.
  By cutting Medicare payments to individual practitioners, we have 
done the opposite of the right thing. We will consolidate healthcare. 
You lose the cheapest way to deliver healthcare to the most people.
  Right now, hospital systems employ 71 percent of all physicians, and 
that is going up every year.
  Physicians deliver healthcare at the lowest possible rate. That is a 
fact. By doing the Medicaid payment cuts just to physicians, not to 
hospital systems, just to physicians at this quantity, you are forcing 
more physicians to work for hospitals, which means less competition and 
higher prices. That is the end-all be-all to what is going to happen 
right now.
  It is not going to save more money. It is going to mean more 
consolidations, more monopolistic practices, higher prices, and worse 
access, because physicians simply won't be out there to accept you as 
patients.
  You will have people retire; you will have people go out of business. 
When those physicians aren't there to take care of you at the most 
rudimentary level, the best and more affordable level, you will have 
nothing but worse patient care and a worse environment for physicians.
  Therefore, I do recommend, just like my colleagues on both sides of 
the aisle, to do the right thing. If people in Congress on both sides 
of the aisle are demanding to do the right thing, why can't we make it 
happen?
  Mr. Speaker, I encourage all of us to stand with our fellow 
physicians in a bipartisan effort to pass legislation to prevent cuts 
to the Medicare payments to physicians.
  Mr. MURPHY. Mr. Speaker, may I inquire how much time I have 
remaining?
  The SPEAKER pro tempore. The gentleman has 9 minutes remaining.
  Mr. MURPHY. Mr. Speaker, I have seen Medicare patients for more than 
30 years. I have had individuals come in my office after I have 
operated on and cared for them in the hospital and apologized, flat out 
apologized for the lack of payment that we received from Medicare.
  I tell them I do it because I love operating and taking care of 
people, but there comes a point where you have to keep the lights on, 
you have to pay your nurses, and pay your mortgage.
  Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs. 
Harshbarger), a doctor of pharmacy, to talk about the ridiculous cuts 
that are facing our colleagues as physicians.
  Mrs. HARSHBARGER. Mr. Speaker, I rise today to address the rising 
cost of healthcare due to inflation and the need to address Medicare 
physician payments to ensure quality care for our seniors.
  Adjusting for inflation and practice costs, Medicare physician pay 
has declined over 25 percent since 2001.
  Despite this important statistic, Medicare payment updates are 
scheduled for all healthcare providers except physicians in 2024.
  Last November, CMS finalized a rule that would decrease Medicare 
reimbursement for physician services by 3.37 percent this year. 
Combined with 3 years of consecutive cuts to Medicare and the rising 
practice costs, Medicare payments have been cut by nearly 10 percent.
  Mr. Speaker, what physician will continue to practice when their 
salaries are being cut by 10 percent?
  It is critical that Congress takes action to address these 
unsustainable Medicare cuts immediately in order to ensure that 
patients continue receiving quality care.
  The negative effects of these cuts will hit our seniors living in 
rural areas the hardest; areas that already face significant healthcare 
challenges.
  As a community pharmacist in one of the country's most rural 
districts and co-chair of the Rural Healthcare Caucus, I urge the House 
and Senate to act

[[Page H185]]

swiftly on passing legislation that would stabilize Medicare payments 
to physicians and other providers to ensure that our seniors maintain 
access to quality healthcare.
  Mr. MURPHY. Mr. Speaker, we submitted a bill, H.R. 6683, a couple 
weeks ago, and while ENC was able to keep the cut at 1.25 percent, we 
are actually desiring to not allow the cut at all. We are taking money 
from the Medicare Improvement Fund, which is what the money is for, to 
solve problems within Medicare.
  Unfortunately, as this was a wonderful bipartisan discussion this 
evening, we are oftentimes imprisoned, if you will, sometimes to the 
will of some of the leaders over in Senate, sometimes even here in the 
House.
  Leaders over in the Senate didn't want anything for a doctor fix. The 
Democratic leader said, no, we want this huge wish list of things done, 
and we will trade that for the doctor fix.
  Well, guys, you can't take poison pills to try to help physicians. 
This is where there should not be politics whatsoever. We saw both 
sides tonight, Democrats and Republicans, speak about the healthcare of 
patients in this country.
  Mr. Speaker, at some point it is going to snap. At some point, 
whether it be what Obamacare was trying to do, absolutely starve 
private practice so that everybody would either be bought out by 
private equity or have to be assumed by hospital systems. Where, by the 
way, physicians don't work as efficiently, physicians cost more, and 
they see fewer patients. It is a closer ownership care of patients.

  When I was practicing full-time, if another doctor called me and 
said, hey, can you see somebody? My response was always: Do you want me 
to see them today or tomorrow?
  The sad fact is once physicians become employed, not only do they 
cost more to the system, but the work ethic is not as good. That is 
just point-blank what is seen.
  What we need to understand is that private practice is the most 
efficient way of delivering healthcare in this country, but it is also 
the one where we care the most, and we follow up. We are always happy 
to see that next patient and make sure that we keep our doors open.
  At this point, Mr. Speaker, we are going to approach a calamitous 
cliff, if you will, in the next 3 to 5 years with the number of 
surgeons that are available to take care of patients.
  I am a urologist. I take care of disorders of the kidney, prostate, 
and bladder--those type of things. We are the most critically short 
specialty in the country.
  Right now, the median age of individuals practicing urology is my 
age, the age of 60. If now we are not paying doctors enough to stay in 
business, they are going to quit. We are going to make a bad shortage 
even worse. We have to pay those who take care of patients what they 
need to be paid.
  Mr. Speaker, I appreciate that this was a bipartisan discussion this 
evening, something that is easy for our leadership to fix. I ask that 
they do that.
  Mr. Speaker, I yield back the balance of my time.

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