House uses Medicare changes to pay for special needs account bill

Budget analysts estimated the ABLE account program would cost $2.1 billion over 10 years, and lawmakers also used H.Res. 766 to add several provisions — including Medicare program changes — that they said would help pay for the account program.

Those provisions include:

• A program to let a PEO — an employment agency that acts as the official employer for workers who work for another company — get certified to take full responsibility for paying a worker’s employment taxes. Today, the company that uses a worker’s labor has responsibility for paying the employment taxes, even if the company uses a PEO to employ the worker.
• A provision that would keep Medicare from paying for erectile dysfunction aid equipment for men until and unless Medicare can pay for drugs for erectile dysfunction, such as Viagra. Under current rules, Medicare does pay for pumps but cannot pay for Viagra.
• A provision that would require the Centers for Medicare & Medicaid Services (CMS) to speed up part of a new Medicare sustainable growth rate (SGR) provider payment reform measure — or “doc fix” measure. Current law requires CMS to classify 0.5 percent of Medicare physician pay as mispriced, and in need of cutting, each year from 2017 through 2020. The H.Res. 766 provision that modified H.R. 647 would require CMS to find 1 percent of mispriced physician pay spending in 2016 and then find an additional 0.5 percent of mispriced spending in 2017, and another 0.5 percent of mispriced spending in 2018.

Rep. Tom Price, R-Ga., who eventually voted for H.R. 657, said in floor debate on that bill and and H.Res. 766 Wednesday that CMS has no intention of implementing the current SGR doc fix measure. Congress has kept CMS from implementing all previous doc fix measures, and Price noted that CMS has not yet developed a procedure for implementing the current physician spending mispricing detection law.

The current confusion over the doc fix measure leads to instability in Medicare physician payments, and the new provision would make matters worse, Price said.

Rep. Jim McDermott, D-Wash., said the House was using “Medicare as a piggy bank to pay for a tax bill.”

Rep. Frank Pallone, R-N.J., said he believes the PEO provision could affect workers’ ability to form unions and the way other labor laws operate.