Burgess: Delay ACA Implementation Until High Court Rules To Save Money
(http://insidehealthpolicy.com/201108182373258/Health-Daily-News/Daily-News/burgess-delay-aca-implementation-until-high-court-rules-to-save-money/menu-id-212.html)

Rep. Michael Burgess (R-TX), Vice Chair of the Energy and Commerce Subcommittee on Health and one of a handful of physicians in Congress, is using the deficit reduction debate to push for postponing implementation of the Affordable Care Act until the Supreme Court renders a decision on the law's constitutionality -- which it is widely expected to do eventually, especially after two federal appellate courts reached split rulings on the individual mandate. In an interview Tuesday afternoon (Aug. 16), Burgess said delaying the law's spending measures that begin 2014 would save money, though like other Republicans he would like total repeal of the law.

Burgess said the health law poses long-term financial concerns. “We've got the other looming problem in 2014, when the spending really accelerates out of the Affordable Care Act that's really going to be disruptive to the budget,” he told Inside Health Policy. “On a larger scale, if we really wanted to control spending, we could look at postponing the 2014 start date and move that out by -- fill in the blank -- 2 years was my suggestion, but I'm willing to listen to other arguments.”

The Texas Republican, a member of the House Tea Party Caucus, said he has been talking to the Republican leadership all year about his idea of delaying implementation of the law, but hasn't officially introduced legislation yet. He conceded that he's “not sure” Democrats -- who view the law as a signature achievement -- would be willing to go along with it.

“Clearly it's all building up to a point where the Supreme Court is eventually going to rule,” Burgess said. “All I would ask is, can we postpone the expense of implementation until we see which way this thing is going.” Burgess said the federal government is spending tens of billions every year to implement the law -- money that, he argued, may end up being spent for no good purpose if the Supreme Court decrees some or all of the measure unconstitutional. “So if we could just agree to put a hold on the spending until we see the direction that this thing is going to go.”

The 11th U.S. Circuit Court of Appeals ruled last Friday (Aug. 12) that the law's requirement that all Americans purchase health insurance, a key pillar of the measure, is unconstitutional. Late June, the 6th U.S. Circuit Court of Appeals upheld the mandate. The split decisions by two appellate courts on the constitutionality of a federal statute makes it highly likely that the case will end up in the Supreme Court, judicial experts say -- it may potentially happen as soon as next year, or it could take several years. It's unclear how effective the law would be without the individual mandate, the aim of which is to expand coverage, broaden the insurance risk pool and hold down costs.

Burgess, who is seen as a leading champion of fixing the Medicare sustainable growth rate physician (SGR) payment formula, said he supports replacing it but isn't sure the debt-reduction super committee would be the appropriate venue to do so. The American Medical Association and other physician groups want the panel to replace the formula, but the Texan fretted -- echoing Senate Minority Whip Jon Kyl (R-AZ) -- that doing so could run contrary to the super committee's efforts to reduce the long-term national debt.

“My position has always been the SGR is a separate issue -- it should be a separate problem,” Burgess explained. “To me the debt limit has always been about cutting. The SGR is obviously about the opposite of cutting.” If no action is taken, physicians will face a 30 percent Medicare pay cut starting Jan. 1. Burgess said Congress will have to tackle the SGR possibly around the same time as it renders a verdict on a super committee package. One option is a short-term patch; another is a replacing the formula, which is expected to cost upwards of $300 billion. The congressman's preference?

“I am always for a permanent fix,” he said.

The physician-turned-congressman said it's too early to say which proposals the super committee should put forth to rein in Medicare and Medicaid expenses -- a variety of possibilities with potential for bipartisan agreement were floated during the Vice President Biden-led phase of the negotiations. Burgess argued that the Affordable Care Act must be on the table for the panel to seek cuts in, due to the “vast explosion” of spending under the law's subsidies beginning in 2014. “You've got to include it,” he said.