Passage of legislation in Congress is more complicated than most people realize. The Constitution allows each chamber of Congress to set its own rules for getting it done.
Because the House of Representatives has 435 members its rules are much less complicated than the Senate’s, which has 100 members. If the House had the same rules as the Senate, nothing would ever be accomplished.
Last week we told you that unless Congress passed new legislation soon, there would be significant cuts in Medicare payments to health care providers, such as doctors and hospitals. And if that happened it is quite possible those patients covered by Medicare would likely face negative consequences with regard to their health care.
The House of Representatives did pass the needed legislation last week so now it moves to the Senate, where passage is not certain. That’s because the Senate is equally divided 50-50 and no Republicans said they would support President Biden’s Covid relief bill, which resulted in a 50-50 vote on the legislation.
When a Senate vote is tied, the Vice President, who the Constitution designates as the President of the Senate, can cast the tie-breaking vote, which is exactly what happened.
The uncertainty of Senate passage of the new legislation to waive the cuts to Medicare comes about because of the 2010 Statutory Pay-As-You-Go Act, which requires across-the-board cuts, known as sequestration, to “mandatory” programs if any new legislation increases the deficit.
Mandatory programs are those, like Medicare, that are automatically funded every year without passage of annual legislation to pay for them. Congress can, however, waive the PAYGO rules to avoid the payment cuts.
However, if a waiver would have been included in the Covid relief bill Senate rules would have required there that 60 votes in favor of passage would be needed instead of a simple majority of 51.
Because there was no waiver in the Covid relief bill, new legislation to waive the mandatory cuts is needed. Congress passed a similar waiver for Republicans’ 2017 tax overhaul, which was passed in the same manner as the Covid-19 relief bill.
Without passage of the waiver legislation the Office of Management and Budget will impose the Medicare payment cuts at the end of the current congressional session. While Social Security, low-income programs such as Medicaid, and veterans’ benefits are exempt from sequestration, Medicare payments can be reduced up to 4%.
While there is no estimate of how large the cuts would be under the legislation that just passed, the Congressional Budget Office estimated that a previous version of the Covid relief bill would have triggered about $36 billion in cuts to Medicare in fiscal 2022 and between $80 and $90 billion from other mandatory programs.
TSCL strongly supports passage of the waiver legislation because of the potentially severe negative consequences they would eventually have on Medicare patients.