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Viewpoint | ONLINE FIRST

Health Policy and the American Taxpayer Relief Act Legislation by Extension

Robert P. Kocher, MD; Eli Y. Adashi, MD, MS
JAMA. 2013;309(8):777-778. doi:10.1001/jama.2013.884.
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On January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012 (ATRA) against the backdrop of the proverbial “fiscal cliff.”1 The product of a last-minute scramble, ATRA extended income and capital gain tax rates for all but the top earners and extended the federal unemployment benefits.1 In addition, however, Title VI of ATRA (Medicare and Other Health Extensions) enacted 29 health policy provisions dominated by the year-long extension of the current Medicare physician fee schedule.1 In so doing, ATRA overrode the impending 26.5% reduction in Medicare payments to physicians mandated by the Sustainable Growth Rate (SGR) formula of the Balanced Budget Act of 1997.2 Other expiring health policy provisions were similarly extended.1 All told, 16 health policy provisions were temporarily extended at a cumulative 10-year cost approximating $30 billion.3 In this Viewpoint, we review these newly enacted if time-limited health policies while pointing out that the practice of legislation by extension is inimical to the maintenance of market stability and antithetical to the formulation of an enlightened long-term national health policy.

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