As the House returns Monday for its first legislative week after Republicans caved on the Department of Homeland Security funding bill, GOP leaders are gearing up for their next battle: the Sustainable Growth Rate.  

SGR, as it’s more commonly known, deals with the payment formula for Medicare doctors. If the current “patch” expires on March 31, Medicare payments to doctors would be reduced by 21 percent. The only problem is the last time Congress extended the so-called “doc fix,” they didn’t exactly have the votes — a conundrum leaders solved by quickly voice voting the measure before members on the floor even realized what had hit them . While an internal memo obtained by CQ Roll Call points out that Republicans don’t expect to deal with SGR legislation until the week of March 23, this week will be key in deciding whether Congress does another short-term patch, or whether it can actually get a long-term legislative solution.  

For quite a while now, aides and lawmakers have expected another patch — Congress has now opted for a short-term SGR solution 17 times — but there have also been some rumors that a deal could come together where the SGR formula would be repealed and the Children’s Health Insurance Program would be extended. Republicans could win on some yet-to-be-named changes to the Medicare payment system, while the extension — even potential expansion — of the Children’s Health Insurance Program would be a carrot to Democrats.  

Fiscal conservatives, however, are already raising flags over the impact of a long-term deal, which could add to the deficit billions more than another short-term patch.  

“Far from a gimmick, the annual Medicare ‘doc fix’ process has saved taxpayers $165 billion since 2003,” Dan Holler, the communications director for Heritage Action said in a statement earlier this week. “Any permanent solution must be financed with permanent Medicare savings, period.”  

Holler went on to say that Americans didn’t hand Republicans a historic House majority to engage in “more deficit spending and budget gimmickry.”  

“Any deal that only offsets a fraction of the cost, like the one currently being discussed behind closed doors and leaked to the press,” Holler said, “is a non-starter for conservatives.”  

Whether a potential deal is a non-starter for conservatives might not matter so much if Republicans cut a deal with Democrats for a permanent fix. It also might not matter if GOP leaders have decided a long-term deal isn’t in the cards. Either way, Republican and Democratic leadership will be sorting it out.  

In keeping with the health care theme, the House is tackling a number of health-related suspension bills. None of the eight bills are really controversial, which is why they’ll be considered under suspension of the rules with a two-thirds majority required for passage. But they will allow leaders to stake out their health care positions.  

The House is also slated to consider three bills via a rule: a bill dealing with the EPA Science Advisory Board, another EPA bill that would prevent the agency from proposing or finalizing regulations based on science that is not “transparent or reproducible”; and a congressional resolution stating a disapproval of a National Labor Relations Board rule related to representation case procedures.  

Related:

Conservatives Still Fuming Over Secret ‘Doc Fix’ Voice Vote


The 114th: CQ Roll Call’s Guide to the New Congress


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