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113th Congress, Vote 135; House of Representatives #4015

SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Official Title: To amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and improve Medicare payments for physicians and other professionals, and for other purposes.

HR 4015: SGR Repeal and Medicare Provider Payment Modernization Act of 2014
Passed by the House March 14, 2014, 238-181 (12 abstaining).

Synopsis: Medicare’s Sustainable Growth Rate (SGR) formula was enacted in 1997 as a means to keep Medicare spending in line with overall economic growth. Although it worked well initially, medical costs far outpaced GDP growth in later years, resulting in annual "doc fix" legislation to prevent significant cuts to Medicare provider reimbursement rates.

Following the SGR formula in 2014 would have resulted in a 24 percent cut in payments to Medicare providers. This was universally unpopular, but avoiding it would require either legislation to repeal and replace the SGR, or another doc fix patch to delay the payment cuts for one more year. HR 4015 endeavored to fix the problem once and for all by repealing the SGR and replacing it with a new provider reimbursement formula.

HR 4015 would implement a Medicare provider reimbursement increase of half a percent each year from 2014 to 2018, followed by a reimbursement freeze from 2019 through 2023. After that, reimbursements would grow by 1 percent annually for doctors who participate in voluntary alternative payment models, and by half a percent for those who don’t. Starting in 2018, HR4015’s merit-based incentive payment system (MIPS) would also provide bonuses of 4 to 9 percent for physicians who rate highly on the quality of care metrics in the MIPS.

There was bipartisan support for the logistics of the SGR repeal/replace portion of HR4015, but Rep. Dave Camp (R – Michigan, and Chairman of the House Ways and Means Committee) added an amendment that would delay the ACA’s individual mandate penalty for five years. Although the amendment would save the government $170 billion over the next decade – more than enough to fund the new Medicare payment increases – Democrats rejected this aspect of the legislation, and bipartisan support withered at that point. As a result, 2014 was once again a "doc fix" year – lawmakers passed HR 4302 instead, which simply delayed the SGR’s Medicare provider reimbursement cut for another year.

Why supporters pushed for this bill

  • If the SGR’s 24 percent reimbursement cut were to be implemented in 2014, the Congressional Budget Office (CBO) estimated that it would take ten years for reimbursement rates to eventually get back up to where they were in early 2014. Lawmakers, providers, and patient advocates were all concerned that this would result in doctors leaving the Medicare system, and a disruption of provider access for Medicare patients.
  • HR 4015 would be a net financial gain for the government. The CBO estimated that HR 4015’s new provider reimbursement formula would cost $138 billion over the next decade, but Rep. Camp’s amendment to delay the individual mandate would save the government about $170 billion over that same time frame, since fewer people would enroll in Medicaid and subsidized health insurance coverage.
  • The American Medical Association and most other physician organizations supported HR 4015. Although the reimbursement increases in HR4015 are modest, they are steady and predictable, eliminating the uncertainty that has plagued Medicare reimbursement for more than a decade.
  • HR 4015 would be a permanent fix, so Congress wouldn’t have to enact doc fix legislation each year. An extensive group of medical organizations opposed the 2014 doc fix legislation, preferring HR4015 instead.
  • Supporters noted that the twelve previous doc fix patches had cost a total of $150 billion, and that continuing to implement temporary solutions each year was not a sustainable solution.

Why opponents tried to stop the bill

  • Although there was a general consensus that the SGR needed to be replaced, Democrats and ACA supporters were unwilling to agree to finance the new Medicare payment model by delaying the individual mandate penalty for five years.
  • Delaying the individual mandate penalty would result in millions more people without health insurance. The CBO estimated that if the individual mandate penalties were to be delayed until 2019, there would be about 43 million uninsured people in the US in 2018 – roughly 13 million more than there would be if the penalties were not delayed.
  • Democrats in Congress rejected the notion of tying together SGR repeal and a delay of the ACA’s individual mandate penalty. They viewed the latter as yet another attempt by ACA opponents to derail the ACA, and Democratic support of HR 4015 disappeared almost completely when Camp’s amendment was added to the bill.
03/14/2014 Status: House passed

More: select a member to see his or her other key Medicare votes.

Yes (238)
R Don Young AK
R Robert Aderholt AL
R Spencer Bachus AL
R Mo Brooks AL
R Bradley Byrne AL
R Martha Roby AL
R Mike Rogers AL
R Tom Cotton AR
R Eric Crawford AR
R Tim Griffin AR
R Steve Womack AR
D Ron Barber AZ
R Matt Salmon AZ
R David Schweikert AZ
D Kyrsten Sinema AZ
D Ami Bera CA
R Ken Calvert CA
R John Campbell CA
R Paul Cook CA
R Jeff Denham CA
R Duncan Hunter CA
R Darrell Issa CA
R Doug LaMalfa CA
R Kevin McCarthy CA
R Tom McClintock CA
R Howard McKeon CA
R Gary Miller CA
R Devin Nunes CA
D Scott Peters CA
R Dana Rohrabacher CA
R Edward Royce CA
R David Valadao CA
R Mike Coffman CO
R Cory Gardner CO
R Doug Lamborn CO
R Scott Tipton CO
R Gus Bilirakis FL
R Vern Buchanan FL
R Ander Crenshaw FL
R Ron DeSantis FL
R Mario Diaz-Balart FL
D Joe Garcia FL
R David Jolly FL
R John Mica FL
R Jeff Miller FL
D Patrick Murphy FL
R Richard Nugent FL
R Bill Posey FL
R Thomas Rooney FL
R Ileana Ros-Lehtinen FL
R Dennis Ross FL
R Steve Southerland FL
R Daniel Webster FL
R Ted Yoho FL
D John Barrow GA
R Paul Broun GA
R Doug Collins GA
R Phil Gingrey GA
R Tom Graves GA
R Jack Kingston GA
R Tom Price GA
R Austin Scott GA
R Lynn Westmoreland GA
R Rob Woodall GA
R Steve King IA
R Tom Latham IA
R Raúl Labrador ID
R Michael Simpson ID
R Rodney Davis IL
R Randy Hultgren IL
R Adam Kinzinger IL
R Peter Roskam IL
D Bradley Schneider IL
R Aaron Schock IL
R John Shimkus IL
R Susan Brooks IN
R Larry Bucshon IN
R Luke Messer IN
R Todd Rokita IN
R Marlin Stutzman IN
R Jackie Walorski IN
R Todd Young IN
R Tim Huelskamp KS
R Lynn Jenkins KS
R Mike Pompeo KS
R Kevin Yoder KS
R Garland Barr KY
R Brett Guthrie KY
R Thomas Massie KY
R Harold Rogers KY
R Ed Whitfield KY
R Charles Boustany LA
R Bill Cassidy LA
R John Fleming LA
R Vance McAllister LA
R Steve Scalise LA
R Andy Harris MD
R Justin Amash MI
R Dan Benishek MI
R Kerry Bentivolio MI
R Dave Camp MI
R Bill Huizenga MI
R Candice Miller MI
R Mike Rogers MI
R Fred Upton MI
R Tim Walberg MI
R John Kline MN
R Erik Paulsen MN
D Collin Peterson MN
R Sam Graves MO
R Vicky Hartzler MO
R Billy Long MO
R Blaine Luetkemeyer MO
R Jason Smith MO
R Ann Wagner MO
R Gregg Harper MS
R Alan Nunnelee MS
R Steven Palazzo MS
R Steve Daines MT
R Howard Coble NC
R Renee Ellmers NC
R Virginia Foxx NC
R George Holding NC
R Richard Hudson NC
R Walter Jones NC
R Patrick McHenry NC
D Mike McIntyre NC
R Mark Meadows NC
R Robert Pittenger NC
R Kevin Cramer ND
R Jeff Fortenberry NE
R Adrian Smith NE
R Lee Terry NE
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
R Leonard Lance NJ
R Frank LoBiondo NJ
R Jon Runyan NJ
R Christopher Smith NJ
R Stevan Pearce NM
R Joseph Heck NV
R Chris Collins NY
R Christopher Gibson NY
R Michael Grimm NY
R Richard Hanna NY
R Peter King NY
R Tom Reed NY
R Steve Chabot OH
R Bob Gibbs OH
R Bill Johnson OH
R Jim Jordan OH
R David Joyce OH
R Robert Latta OH
R James Renacci OH
R Steve Stivers OH
R Patrick Tiberi OH
R Michael Turner OH
R Brad Wenstrup OH
R Jim Bridenstine OK
R Tom Cole OK
R James Lankford OK
R Frank Lucas OK
R Markwayne Mullin OK
R Greg Walden OR
R Lou Barletta PA
R Charles Dent PA
R Michael Fitzpatrick PA
R Jim Gerlach PA
R Mike Kelly PA
R Tom Marino PA
R Patrick Meehan PA
R Tim Murphy PA
R Scott Perry PA
R Joseph Pitts PA
R Keith Rothfus PA
R Bill Shuster PA
R Glenn Thompson PA
R Jeff Duncan SC
R Mick Mulvaney SC
R Tom Rice SC
R Marshall Sanford SC
R Joe Wilson SC
R Kristi Noem SD
R Diane Black TN
R Marsha Blackburn TN
R Scott DesJarlais TN
R John Duncan TN
R Stephen Fincher TN
R Charles Fleischmann TN
R David Roe TN
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R John Carter TX
R K. Conaway TX
R Blake Farenthold TX
R Bill Flores TX
R Louie Gohmert TX
R Kay Granger TX
R Ralph Hall TX
R Jeb Hensarling TX
R Sam Johnson TX
R Kenny Marchant TX
R Michael McCaul TX
R Randy Neugebauer TX
R Pete Olson TX
R Ted Poe TX
R Pete Sessions TX
R Lamar Smith TX
R Steve Stockman TX
R Mac Thornberry TX
R Randy Weber TX
R Roger Williams TX
R Rob Bishop UT
R Jason Chaffetz UT
D Jim Matheson UT
R Chris Stewart UT
R Eric Cantor VA
R J. Forbes VA
R Bob Goodlatte VA
R H. Griffith VA
R Robert Hurt VA
R Edward Rigell VA
R Robert Wittman VA
R Frank Wolf VA
R Doc Hastings WA
R J. Herrera Beutler WA
R C. McMorris Rodgers WA
R David Reichert WA
R Sean Duffy WI
R Thomas Petri WI
R Reid Ribble WI
R Paul Ryan WI
R F. Sensenbrenner WI
R Shelley Capito WV
R David McKinley WV
D Nick Rahall WV
R Cynthia Lummis WY
No (181)
Our pick
D Terri Sewell AL
D Raúl Grijalva AZ
D Ann Kirkpatrick AZ
D Ed Pastor AZ
D Xavier Becerra CA
D Julia Brownley CA
D Lois Capps CA
D Tony Cárdenas CA
D Judy Chu CA
D Jim Costa CA
D Susan Davis CA
D Anna Eshoo CA
D Sam Farr CA
D John Garamendi CA
D Janice Hahn CA
D Michael Honda CA
D Jared Huffman CA
D Barbara Lee CA
D Zoe Lofgren CA
D Alan Lowenthal CA
D Doris Matsui CA
D Jerry McNerney CA
D George Miller CA
D Grace Napolitano CA
D G. Negrete McLeod CA
D Nancy Pelosi CA
D L. Roybal-Allard CA
D Raul Ruiz CA
D Linda Sánchez CA
D Loretta Sanchez CA
D Adam Schiff CA
D Brad Sherman CA
D Jackie Speier CA
D Eric Swalwell CA
D Mark Takano CA
D Mike Thompson CA
D Juan Vargas CA
D Maxine Waters CA
D Henry Waxman CA
D Diana DeGette CO
D Ed Perlmutter CO
D Jared Polis CO
D Rosa DeLauro CT
D Elizabeth Esty CT
D James Himes CT
D John Larson CT
D John Carney DE
D Corrine Brown FL
D Kathy Castor FL
D Theodore Deutch FL
D Lois Frankel FL
D Alan Grayson FL
D Alcee Hastings FL
D D. Wasserman Schultz FL
D Frederica Wilson FL
D Sanford Bishop GA
D Henry Johnson GA
D John Lewis GA
D David Scott GA
D Tulsi Gabbard HI
D Colleen Hanabusa HI
D Bruce Braley IA
D David Loebsack IA
D Cheri Bustos IL
D Tammy Duckworth IL
D William Enyart IL
D Bill Foster IL
D Luis Gutiérrez IL
D Robin Kelly IL
D Daniel Lipinski IL
D Mike Quigley IL
D Janice Schakowsky IL
D André Carson IN
D Peter Visclosky IN
D John Yarmuth KY
D Cedric Richmond LA
D Michael Capuano MA
D Katherine Clark MA
D William Keating MA
D Joseph Kennedy MA
D Stephen Lynch MA
D James McGovern MA
D Richard Neal MA
D John Tierney MA
D Niki Tsongas MA
D Elijah Cummings MD
D John Delaney MD
D Donna Edwards MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Michael Michaud ME
D Chellie Pingree ME
D John Conyers MI
D Daniel Kildee MI
D Sander Levin MI
D Gary Peters MI
D Keith Ellison MN
D Betty McCollum MN
D Richard Nolan MN
D Timothy Walz MN
D Wm. Clay MO
D Emanuel Cleaver MO
D Bennie Thompson MS
D George Butterfield NC
D David Price NC
D Ann Kuster NH
D Carol Shea-Porter NH
D Rush Holt NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Donald Payne NJ
D Albio Sires NJ
D Ben Luján NM
D M. Lujan Grisham NM
D Steven Horsford NV
D Dina Titus NV
D Timothy Bishop NY
D Yvette Clarke NY
D Joseph Crowley NY
D Eliot Engel NY
D Brian Higgins NY
D Steve Israel NY
D Hakeem Jeffries NY
D Nita Lowey NY
D Daniel Maffei NY
D Carolyn Maloney NY
D Sean Maloney NY
D Carolyn McCarthy NY
D Gregory Meeks NY
D Grace Meng NY
D Jerrold Nadler NY
D William Owens NY
D Charles Rangel NY
D José Serrano NY
D Louise Slaughter NY
D Paul Tonko NY
D Nydia Velázquez NY
D Joyce Beatty OH
D Marcia Fudge OH
D Marcy Kaptur OH
D Tim Ryan OH
D Earl Blumenauer OR
D Suzanne Bonamici OR
D Peter DeFazio OR
D Kurt Schrader OR
D Robert Brady PA
D Matthew Cartwright PA
D Michael Doyle PA
D Chaka Fattah PA
D Allyson Schwartz PA
D David Cicilline RI
D James Langevin RI
D James Clyburn SC
D Steve Cohen TN
D Jim Cooper TN
D Joaquin Castro TX
D Henry Cuellar TX
D Lloyd Doggett TX
D Pete Gallego TX
D Al Green TX
D Gene Green TX
D Rubén Hinojosa TX
D Sheila Jackson Lee TX
D Eddie Johnson TX
D Beto O’Rourke TX
D Marc Veasey TX
D Filemon Vela TX
D Gerald Connolly VA
D James Moran VA
D Robert Scott VA
D Peter Welch VT
D Suzan DelBene WA
D Denny Heck WA
D Derek Kilmer WA
D Rick Larsen WA
D Jim McDermott WA
D Ron Kind WI
D Gwen Moore WI
D Mark Pocan WI
Not Voting (12)
R Trent Franks AZ
R Paul Gosar AZ
D Karen Bass CA
D Joe Courtney CT
D Danny Davis IL
D Bobby Rush IL
D John Dingell MI
R Michele Bachmann MN
R Mark Amodei NV
R Trey Gowdy SC
R John Culberson TX
D Adam Smith WA