The House Energy and Commerce Committee immediately tackled Medicare's physician payment problem when it resumed negotiations on the House healthcare reform bill, defeating a Republican amendment to replace Medicare's sustainable growth rate, or SGR, formula.

Debate began when Rep. Michael Burgess (R-Texas), a physician, offered an amendment that would replace the SGR formula with one based on Medicare's Economic Index. The America's Affordable Health Choices Act as currently written does contain a plan to revamp Medicare physician payments, but is still based on the SGR.

“Doctors are in a position to face yearly cuts because the (SGR) formula is still linked to the gross domestic product,” Burgess said. This alternative would result in more stable and predictable payments to physicians, he said.

Democrats countered that the current bill's overhaul of the SGR would fall within the pay-as-you-go requirements, and that Burgess' amendment was fiscally irresponsible. “It would add $60 billion to the cost of the bill; I don't see a way to pay for it,” said Rep. Henry Waxman (D-Calif.), the committee's chairman. The amendment was defeated by a roll call vote of 32-20.

Waxman resumed negotiations on the bill with the awareness that not everyone on the panel was completely onboard with the legislation. Rep. Bart Stupak (D-Mich.), who believes the bill contains a hidden abortion funding mandate, has made it clear he won't vote for the bill.

When asked by ranking member Rep. Joe Barton (R-Texas) if there was a chance of pushing off committee negotiations until the fall, Waxman responded, “I hope we don't come to that situation.”