Jobless, Medicare action nears

Congress may have punted deadlines for a government shutdown and a debt ceiling deal into 2014, but the clock is ticking on two entitlement programs that will expire in December, stripping away benefits for millions of people in the new year if lawmakers don’t act.

Enhanced unemployment benefits for the long-term jobless are set to expire Dec. 28. Democrats introduced a bill Wednesday to extend them for one more year, arguing that too many Americans are still struggling in the sluggish economy.

“Everybody wants the dignity to work,” said Sen. Debbie Stabenow, Michigan Democrat. “Shame on us as the greatest country in the world if we allow policies to go forward that stop that from happening.”

The other program facing an end-of-year deadline is Medicare’s payment rate for doctors. Under the law, payments are supposed to be cut to try to control costs but Congress, fearful it would mean doctors stop treating Medicare patients, regularly overrides the cuts.

If a fix is not put in place by the end of 2013, doctors will face almost a 25 percent pay cut in the new year.

The problem, for both, is finding ways to pay for them in a time when there are so many competing pressures for money — not least the budget sequesters that all sides say they want to replace.

Democrats who introduced the unemployment extension said the cost should be tacked onto the deficit, rather than offset by cuts elsewhere.

“We don’t have any funding in the bill. That’s been true almost always, it’s been considered an emergency, because it is,” said Rep. Sander M. Levin, Michigan Democrat. “They’ll be hit by a hurricane, a financial hurricane.”

Mr. Levin said he believes the budget is the best place to include an extension of emergency unemployment benefits, though it should be passed by any means possible, he said, and could also be tied to another bill or be considered individually.

Rep. Chris Van Hollen, Maryland Democrat and ranking minority member on the budget conference committee, said it has been part of broad talks, but that no decisions have been made on the issue.

“Congress absolutely should not go home in the middle of December without addressing this very important issue,” Mr. Van Hollen said.

Long-term unemployment now accounts for 36 percent of all unemployment and those who have been out of the workplace for more than six months have slim chances of finding a job. Congressional Budget Office Director Douglas Elmendorf told the budget conference committee earlier this month that long-term unemployment is “a very worrisome factor for the economy.”

“Some people who are unemployed for a long time simply give up looking for work. Some people probably find their way into disability insurance,” he said during the Nov. 13 meeting. “It poses a very large risk of there being some set of people who will not find their way back to work at all.”

House Republican leaders have not mentioned extending unemployment insurance as a priority before the end of the year, but they have said they would like to take action on the Medicare-doctors issue.

The House Ways and Means Committee and the Senate Finance Committee released a bipartisan plan in October to permanently fix the doctors’ pay, known as the Sustainable Growth Rate formula. But the plan does not have an official CBO price tag yet, a House committee aide familiar with the proposal said.

“Providing a permanent solution to the broken SGR formula is vital to ensuring that seniors continue to have access to high quality care,” said Rep. Dave Camp, chairman of the House Ways and Means Committee. “Creating a policy that rewards providers for delivering high quality, efficient health care is the ultimate goal, and this draft brings us one step closer to that reality.”

However, the committee aide said there is no timeline for action on the plan and the draft proposal doesn’t include a way to pay for the fix.

The proposal would freeze doctors’ current payment levels for 10 years while allowing physicians to earn incentives for exceptional service.