Federal Relations

Deal on Payroll Tax, Doc Fix, Unemployment

Congressional leaders have reached a tentative deal on a payroll tax cut, extend unemployment benefits, and delay rate cuts to doctors who treat Medicare patients.  Under the proposed plan, a 2-percentage point payroll tax cut would be extended until the end of this calendar year.  The cost of this tax cut would be added to the federal deficit. Unemployment benefits would also be extended for the next 10 months and doctors who treat Medicare patients would avoid seeing their payments cut. Those two provisions would cost about $50 billion and be paid for with cuts elsewhere in the federal budget.

One of the most sensitive issues in the final negotiations was the question of how much Medicare should compensate hospitals for the bad debt accumulated when patients don’t provide their required co-pays for care (uncompensated care). Medicare currently compensates hospitals for 70 percent of their loss and the House proposed to cut this to 55 percent — saving more than $10 billion over 10 years. But this puts a heavy burden on hospitals that provide a lot of uncompensated care – like Harborview.  The final compromise lowers the bad debt cut to about $7 billion, which is better than the original proposal from a couple of months ago but it will still be a blow to hospitals with low-income patients.