Last week, Sen. Wyden introduced a permanent SGR fix: The Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014. This bill represents compromise policy taken from other bipartisan proposals, as well as the extension of certain Medicare programs that are expiring. It does not, however, include a way to pay for these provisions.

While the path forward remains unclear, one thing is true: the current SGR "patch" expires in 19 days. VNAA continues to monitor the debate and will alert members when there is action to take to influence the process. In the meantime, we will provide members with a short update of some of the highlights.

Sen. Orin Hatch (R-UT), ranking member for the Senate Committee on Finance, discussed the possibility of passing the SGR repeal-and-replace bill and stated to Politico, without paying for it and finding funding Republicans can support, Congress will "have to patch it." "It's just that simple," said Hatch. The patch would likely extend beyond the midterm elections to the end of the year.

On March 11, the House GOP Doctors Caucus sent a letter to house lawmakers stating that that if the bill with the Affordable Care Act (ACA) offset passes the House, then bipartisan negotiations on offsets could occur in conference. The Doctors Caucus said they are willing to negotiate bipartisan payment offsets with the Senate.

"We are firmly committed to a permanent repeal of the SGR this year," the dear colleague letter from the Doctors Caucus states. "We cannot accomplish this goal, however, without substantive bipartisan, bicameral agreement on policies to offset the cost of H.R. 4015. Any such reforms must not only receive majority support in both chambers, but also be agreed to by the White House."

President Obama said he would veto the SGR bill the House will take up on Friday because of its individual mandate suspension. "[The bill] includes an offset that would increase health insurance premiums, decrease tax credits, increase the number of uninsured and shift costs to businesses, workers and health care providers," says a statement of administration policy. "It is time for Congress to stop fighting old political battles."