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House|Senate

114th Congress, Vote 144; House of Representatives #2

Medicare Access and CHIP Reauthorization Act of 2015


Official Title: To amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children's Health Insurance Program, and for other purposes.

HR 2: Medicare Access and CHIP reauthorization Act of 2015
Passed by the House March 26, 2015, 392-37 (4 abstaining).
Passed Senate (92-8) on April 14, 2015.
Signed into law April 16, 2015.

Synopsis: There were three primary aspects of HR 2:

  • Repeal and replace the Sustainable Growth Rate (SGR) formula for calculating physicians' Medicare reimbursements.
  • Reauthorize Children's Health Insurance Program (CHIP) funding for another two years.
  • Continue Medicare's transition away from fee-for-service and towards value and quality-based payments.

The law also includes provisions such as extending authorization for Medicare Special Needs Plans (SNPs) and funding for senior resources. But the three main parts of the law are the ones that garnered the most attention.

Overall, repealing and replacing the SGR formula was heralded as HR 2's biggest success. The SGR was implemented in 1997 as a way to keep Medicare spending in check, but for more than a decade, following the SGR formula would have resulted in significant payment cuts for doctors. To prevent those cuts, Congress has enacted 16 temporary "doc fixes"" over the years.

HR 2 eliminates the SGR and the need for the annual "doc fix."" Instead, the law calls for a series of small but steady and predictable payment increases, followed by a payment freeze – but no pay cuts.

CHIP funding had previously only been authorized through September 30, 2015. HR 2 extends that funding for another two years.

MIPS, the Medicare Incentive Based Payment System (value-based payments) will gradually replace Medicare's fee-for-service model. That means doctors will earn more when they have better patient outcomes, less over-treatment, and fewer complications.

Why supporters pushed for this bill

  • HR 2 had significant bipartisan support, which was particularly noteworthy among the string of partisan healthcare-related bills in recent years. Essentially, the SGR and the annual doc fix were so hated that it was relatively easy for congressional leadership to get both sides on board with a permanent solution.
  • HR 2 is expected to shore up Medicare patients? access to doctors by eliminating the reimbursement uncertainties that existed during the SGR years.
  • Although HR 2 will add about $141 billion to the federal deficit over the next decade, supporters note that the outlook improves over a longer time frame. According to a CMS report, by 2048 costs will be lower under HR 2 than they would be under existing law, and by 2085, the savings will be considerable: Medicare prices will be 30 percent less than they would have been under the existing law.
  • Moving away from fee-for-service and towards value-based payment systems should result in less over-treatment and better outcomes for Medicare beneficiaries.

Why opponents tried to stop the bill

  • The most-cited drawback is the cost. The Congressional Budget Office (CBO) projected that HR 2 will result in a $141 billion increase in the federal budget deficit over the period from 2015 to 2025. Fiscal conservatives were generally opposed to the increased short-term spending.
  • MIPS could inadvertently encourage doctors to avoid the sickest and least-compliant patients, since patient outcomes will factor into physician reimbursements.
  • Free-market proponents would have preferred a Medicare reform bill that allowed balance-billing of Medicare patients (not likely to be popular among Medicare beneficiaries) and little to no government involvement in how doctors provide care (ie, no MIPS).
  • HR 2 includes a provision to eliminate first-dollar coverage on Medigap plans for new enrollees starting in 2020. This change is expected to help with over-utilization, since first-dollar coverage allows patients to receive as much care as they want with no out-of-pocket. Some HR 2 opponents would have preferred stronger provisions to eliminate over-utilization.
  • CHIP supporters and Congressional Democrats had initially requested a four year-extension for CHIP, but the final legislation only called for a two-year extension. Some CHIP advocates were reluctant to support the bill as a result, preferring a new bill with a four-year CHIP extension.
03/26/2015 Status: House passed

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

Yes (392)
Our
Pick
R Don Young AK
R Robert Aderholt AL
R Bradley Byrne AL
R Martha Roby AL
R Mike Rogers AL
D Terri Sewell AL
R Eric Crawford AR
R French Hill AR
R Bruce Westerman AR
R Steve Womack AR
R Trent Franks AZ
D Ruben Gallego AZ
R Paul Gosar AZ
D Raúl Grijalva AZ
D Ann Kirkpatrick AZ
R Martha McSally AZ
R Matt Salmon AZ
D Kyrsten Sinema AZ
D Pete Aguilar CA
D Karen Bass CA
D Xavier Becerra CA
D Ami Bera CA
D Julia Brownley CA
R Ken Calvert CA
D Lois Capps CA
D Tony Cárdenas CA
D Judy Chu CA
R Paul Cook CA
D Jim Costa CA
D Susan Davis CA
R Jeff Denham CA
D Mark DeSaulnier 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
R Duncan Hunter CA
R Steve Knight CA
R Doug LaMalfa CA
D Barbara Lee CA
D Ted Lieu CA
D Zoe Lofgren CA
D Alan Lowenthal CA
D Doris Matsui CA
R Kevin McCarthy CA
D Jerry McNerney CA
D Grace Napolitano CA
R Devin Nunes CA
D Nancy Pelosi CA
D Scott Peters CA
R Dana Rohrabacher CA
D L. Roybal-Allard CA
R Edward Royce 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 Norma Torres CA
R David Valadao CA
D Juan Vargas CA
R Mimi Walters CA
D Maxine Waters CA
R Mike Coffman CO
D Diana DeGette CO
R Doug Lamborn CO
D Ed Perlmutter CO
D Jared Polis CO
R Scott Tipton CO
D Joe Courtney CT
D Rosa DeLauro CT
D Elizabeth Esty CT
D James Himes CT
D John Larson CT
D John Carney DE
R Gus Bilirakis FL
D Corrine Brown FL
R Vern Buchanan FL
D Kathy Castor FL
R Curtis Clawson FL
R Ander Crenshaw FL
R Carlos Curbelo FL
D Theodore Deutch FL
R Mario Diaz-Balart FL
D Lois Frankel FL
D Gwen Graham FL
D Alan Grayson FL
D Alcee Hastings 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
D D. Wasserman Schultz FL
R Daniel Webster FL
D Frederica Wilson FL
R Ted Yoho FL
R Rick Allen GA
D Sanford Bishop GA
R Buddy Carter GA
R Doug Collins GA
R Jody Hice GA
D Henry Johnson GA
D John Lewis GA
R Tom Price GA
R Austin Scott GA
D David Scott GA
R Lynn Westmoreland GA
R Rob Woodall GA
D Tulsi Gabbard HI
D Mark Takai HI
D David Loebsack IA
R David Young IA
R Michael Simpson ID
R Mike Bost IL
D Cheri Bustos IL
D Danny Davis IL
R Rodney Davis IL
R Bob Dold IL
D Tammy Duckworth IL
D Bill Foster IL
D Luis Gutiérrez IL
D Robin Kelly IL
R Adam Kinzinger IL
D Daniel Lipinski IL
D Mike Quigley IL
R Peter Roskam IL
D Bobby Rush IL
R Aaron Schock IL
R John Shimkus IL
R Susan Brooks IN
R Larry Bucshon IN
D André Carson IN
R Luke Messer IN
R Todd Rokita IN
R Marlin Stutzman IN
R Jackie Walorski IN
R Todd Young IN
R Lynn Jenkins KS
R Mike Pompeo KS
R Kevin Yoder KS
R Garland Barr KY
R Brett Guthrie KY
R Harold Rogers KY
R Ed Whitfield KY
D John Yarmuth KY
R Ralph Abraham LA
R Charles Boustany LA
R John Fleming LA
R Garret Graves LA
D Cedric Richmond LA
R Steve Scalise 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 Seth Moulton MA
D Richard Neal MA
D Niki Tsongas MA
D Elijah Cummings MD
D John Delaney MD
D Donna Edwards MD
R Andy Harris MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Chellie Pingree ME
R Bruce Poliquin ME
R Dan Benishek MI
R Mike Bishop MI
D John Conyers MI
D Debbie Dingell MI
R Bill Huizenga MI
D Daniel Kildee MI
D Brenda Lawrence MI
D Sander Levin MI
R Candice Miller MI
R John Moolenaar MI
R Dave Trott MI
R Fred Upton MI
R Tim Walberg MI
D Keith Ellison MN
R Tom Emmer MN
R John Kline MN
D Betty McCollum MN
D Richard Nolan MN
R Erik Paulsen MN
D Collin Peterson MN
D Timothy Walz MN
D Wm. Clay MO
D Emanuel Cleaver MO
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 Steven Palazzo MS
D Bennie Thompson MS
R Ryan Zinke MT
D Alma Adams NC
D George Butterfield NC
R Renee Ellmers NC
R Virginia Foxx NC
R George Holding NC
R Richard Hudson NC
R Patrick McHenry NC
R Robert Pittenger NC
D David Price NC
R David Rouzer NC
R Mark Walker NC
R Kevin Cramer ND
D Brad Ashford NE
R Jeff Fortenberry NE
R Adrian Smith NE
R Frank Guinta NH
D Ann Kuster NH
R Rodney Frelinghuysen NJ
R Leonard Lance NJ
R Frank LoBiondo NJ
R Tom MacArthur NJ
D Donald Norcross NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Albio Sires NJ
R Christopher Smith NJ
D B. Watson Coleman NJ
D Ben Luján NM
D M. Lujan Grisham NM
R Stevan Pearce NM
R Mark Amodei NV
R Cresent Hardy NV
R Joseph Heck NV
D Dina Titus NV
D Yvette Clarke NY
R Chris Collins NY
D Joseph Crowley NY
D Eliot Engel NY
R Christopher Gibson NY
R Richard Hanna NY
D Brian Higgins NY
D Steve Israel NY
D Hakeem Jeffries NY
R John Katko NY
R Peter King NY
D Nita Lowey NY
D Carolyn Maloney NY
D Sean Maloney NY
D Gregory Meeks NY
D Grace Meng NY
D Charles Rangel NY
R Tom Reed NY
D Kathleen Rice NY
D José Serrano NY
D Louise Slaughter NY
R Elise Stefanik NY
D Paul Tonko NY
D Nydia Velázquez NY
R Lee Zeldin NY
D Joyce Beatty OH
R John Boehner OH
R Steve Chabot OH
D Marcia Fudge OH
R Bob Gibbs OH
R Bill Johnson OH
R David Joyce OH
D Marcy Kaptur OH
R Robert Latta OH
R James Renacci OH
D Tim Ryan OH
R Steve Stivers OH
R Patrick Tiberi OH
R Michael Turner OH
R Brad Wenstrup OH
R Tom Cole OK
R Frank Lucas OK
R Markwayne Mullin OK
R Steve Russell OK
D Earl Blumenauer OR
D Suzanne Bonamici OR
D Peter DeFazio OR
D Kurt Schrader OR
R Greg Walden OR
R Lou Barletta PA
D Brendan Boyle PA
D Robert Brady PA
D Matthew Cartwright PA
R Ryan Costello PA
R Charles Dent PA
D Michael Doyle PA
D Chaka Fattah PA
R Michael Fitzpatrick 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
D David Cicilline RI
D James Langevin RI
D James Clyburn SC
R Jeff Duncan SC
R Trey Gowdy SC
R Tom Rice SC
R Joe Wilson SC
R Kristi Noem SD
R Diane Black TN
R Marsha Blackburn TN
D Steve Cohen TN
R John Duncan TN
R Stephen Fincher TN
R Charles Fleischmann TN
R David Roe TN
R Brian Babin TX
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R John Carter TX
D Joaquin Castro TX
R K. Conaway TX
D Henry Cuellar TX
R John Culberson TX
D Lloyd Doggett TX
R Blake Farenthold TX
R Bill Flores TX
R Kay Granger TX
D Al Green TX
D Gene Green TX
R Jeb Hensarling TX
R Will Hurd TX
D Sheila Jackson Lee TX
D Eddie Johnson TX
R Michael McCaul TX
R Randy Neugebauer TX
D Beto O'Rourke TX
R Pete Olson TX
R Ted Poe TX
R Pete Sessions TX
R Lamar Smith TX
R Mac Thornberry TX
D Marc Veasey TX
D Filemon Vela TX
R Randy Weber TX
R Roger Williams TX
R Rob Bishop UT
R Jason Chaffetz UT
R Mia Love UT
R Chris Stewart UT
D Donald Beyer VA
R Barbara Comstock VA
D Gerald Connolly VA
R J. Forbes VA
R Bob Goodlatte VA
R H. Griffith VA
R Robert Hurt VA
R Edward Rigell VA
D Robert Scott VA
R Robert Wittman VA
D Peter Welch VT
D Suzan DelBene WA
D Denny Heck WA
R J. Herrera Beutler WA
D Derek Kilmer WA
D Rick Larsen WA
D Jim McDermott WA
R C. McMorris Rodgers WA
R Dan Newhouse WA
R David Reichert WA
R Sean Duffy WI
D Ron Kind WI
D Gwen Moore WI
D Mark Pocan WI
R Reid Ribble WI
R Paul Ryan WI
R Evan Jenkins WV
R David McKinley WV
R Alex Mooney WV
No (37)
R Mo Brooks AL
R Gary Palmer AL
R David Schweikert AZ
R Darrell Issa CA
R Tom McClintock CA
R Ken Buck CO
R Ron DeSantis FL
R David Jolly FL
R Tom Graves GA
R Barry Loudermilk GA
R Rod Blum IA
R Steve King IA
R Raúl Labrador ID
R Randy Hultgren IL
D Janice Schakowsky IL
D Peter Visclosky IN
R Tim Huelskamp KS
R Thomas Massie KY
R Justin Amash MI
R Walter Jones NC
R Mark Meadows NC
R Scott Garrett NJ
D Jerrold Nadler NY
R Jim Jordan OH
R Jim Bridenstine OK
R Mick Mulvaney SC
R Marshall Sanford SC
D Jim Cooper TN
R Scott DesJarlais TN
R Louie Gohmert TX
R Sam Johnson TX
R Kenny Marchant TX
R John Ratcliffe TX
R David Brat VA
R Glenn Grothman WI
R F. Sensenbrenner WI
R Cynthia Lummis WY
Not Voting (4)
D Raul Ruiz CA
D Donald Payne NJ
D Rubén Hinojosa TX
D Adam Smith WA