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Dems Moving on the Doc-Fix?

It appears that way. House Speaker Nancy Pelosi (D-Calif.) summoned members of the doctors lobby to Capitol Hill Wednesday evening for an update on the Democrats’ plans to prevent Medicare doctors from receiving a 21 percent pay cut at the end of this month.

She doesn’t have an easy sell.

The American Medical Association, the nation’s largest doctors lobby, agreed to support health care reform under the condition that Democrats would return later in the year to scrap the sustainable growth rate (SGR), the flawed formula dictating doctors’ Medicare payments. Trouble is, the cost of doing so runs upwards of $200 billion, and Senate budget hawks from both parties aren’t about to let such an enormous expense fly through the chamber without offsets elsewhere in the budget.

Which introduces the second problem: Where do Democrats find $200+ billion at a time when budget deficits are already well above $1 trillion? (Answer: They don’t.)

Historically, Congress has allocated temporary funds to prevent similar SGR-dictated cuts from hitting Medicare doctors, and they’ll almost certainly have to go that route again this year. But that plan risks alienating the powerful AMA, which has been crystal clear about its unwillingness to accept anything less than a full repeal of the SGR.

“The AMA cannot support a proposal that would result in steeper future payment cuts and a substantially higher cost for a permanent solution, making it more difficult, if not impossible to repeal the Medicare physician payment formula,” J. James Rohack, the president of the AMA, said in a statement.

The political pickle for Pelosi and the Democrats is this: How to prevent the Medicare cut without (1) adding too much to the deficit, and (2) reneging on a promise to the AMA that could haunt you in November?

And you thought your job was stressful.

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