When the Senate reconvenes on April 13, it will have 48 hours to pass legislation that repeals Medicare’s Sustainable Growth Rate – otherwise, physicians treating program beneficiaries will see their pay cut by 21 percent. That puts senators who have qualms with the legislation in a tight spot, pressuring them to vote on a bill they might otherwise want to spend more time debating.

While the SGR nominally went into effect on April 1, the Centers for Medicare and Medicaid Services (CMS) has thus far delayed implementing the cuts; on April 15, the center said, they will start processing payments. Senate Majority Leader Mitch McConnell (R-Ky.) said the chamber would take up the bill, H.R. 2, when lawmakers return from a two-week recess; before the chamber adjourned, Minority Leader Harry Reid (D-Nev.) stated his preference that there be “a very limited number of amendments” taken into consideration.

“Members will discuss the path forward, but we expect it will be done quickly,” Robert Steurer, a spokesman for McConnell, said in an email.

But that hasn’t stopped a handful of Senate Democrats from criticizing the bill for only funding the Children’s Health Insurance Program through fiscal year 2017. The 12 Democrats on the Senate Finance Committee said in a joint statement last month that they would like to see CHIP extended through fiscal 2019.

But extending CHIP for four years instead of two would make the bill more expensive, and some Republicans are already lukewarm about the fact that the legislation would add $141 billion to the deficit, according to an estimate from the Congressional Budget Office.

Most Senate Republicans appear willing to add to the deficit if it means repealing the SGR, but it’s still a hard pill for them to swallow, and for a select few it’s been a deal breaker. Freshman Sen. Ben Sasse of Nebraska urged his party colleagues in an op-ed to oppose the bill because it’s not fully paid for.

William Hoagland, senior vice president of the Washington-based Bipartisan Policy Center, said the pressure to pass the bill will likely preclude any amendments from garnering the 60 votes needed.

“Although I think senators will have an opportunity to vote on amendments and express their concerns, I don’t think it will change the outcome,” Hoagland said in an interview.

It is unclear whether Democrats will actually propose extending CHIP for four years when the Senate reconvenes. A Senate Democratic aide familiar with the matter said there has been “informal discussion” about offering an amendment to extend funding.

Sen. Ben Cardin (D-Md.) is pushing for an amendment that would repeal the $1,940 monetary cap on therapy services that Medicare beneficiaries are subject to. The House-passed bill awaiting Senate consideration would extend exceptions to the cap through Dec. 31, 2017. Cardin tried unsuccessfully in 2011 to repeal the cap.

“He is hopeful that there will be an opportunity to offer an amendment to repeal these arbitrary therapy caps when the Senate considers the SGR bill,” Sue Walitsky, a spokeswoman for Cardin, said in an email.

Lobbyists are a driving force behind potential amendments to the legislation. The American Association of Retired Persons, the nation’s most prominent seniors lobby, and the American Health Care Association, which represents the nursing community, are working to repeal the therapy cap. First Focus Campaign For Children, a children’s advocacy group, is lobbying Senate Democrats to extend CHIP funding through fiscal 2019.

If the Senate passes the SGR repeal, Hoagland, who was the Senate Budget Committee’s staff director for more than two decades, said it would not only be a fundamental policy achievement but also a rare example of a grand bargain during a time of fierce partisanship.

“The fact that this was done on a bipartisan basis and dealt with something as big as Medicare, with some changes that quite frankly will make some people mad,” Hoagland said. “This is something that Speaker Boehner and Mrs. Pelosi should take a little bit of pride in – that Congress can work and they can come together on these critical issues.”

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