What a week it’s been in Washington! It feels like every week there is a new non-development in the Medicare Sustainable Growth Rate (SGR) saga, but this week we swear there is actually some progress worth reporting. Last week we noted that Congress was inching closer to presenting a bipartisan deal, with sign-off in the House from both Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA), but that the folks in the Senate were less certain about the plan. This week, we can report that the SGR has been passed out of the House by a very comfortable margin, support in the Senate is growing and President Obama has given it the thumbs up.

One development that helped sway many members of Congress was the announcement that fixing the problem permanently would cost just about the same as kicking the can down the road 10 more times. Before Congress votes on any legislation, the Congressional Budget Office (CBO) is required to weigh-in and determine a budget “score” of the bill, showing what the measure will “cost” the federal government over the next 10 years. The permanent fix itself has a price-tag of just north of $200 billion over the next 10 years, but the cost to the government—excluding the offsets that were included in the bill—brings the estimated increase to the federal deficit to about $141 billion between now and 2025. This total is almost identical to what the score would have been if Congress were to freeze physician reimbursements over the next 10 years.

With the CBO score in, the House was able to bring the bill to the floor on Thursday. Despite some misgivings over the past week from some of the more conservative or tea party members of the Republican Party due to the bill not being fully offset by other budget cuts or revenue enhancements, and by some Democrats who didn’t see the two-year extension of the Children’s Health Insurance Program (CHIP) as long enough, members mostly fell in line for the vote. President Obama signaled on Wednesday that he was in favor of the package and would sign it if it came to his desk, which helped to bring Democrats along and remarkably didn’t automatically kill support for it among Republicans. The bill passed with 392 yes votes and 37 no votes cast by 33 Republicans and 4 Democrats. If you’re like us and aren’t capable of doing that math in your head, that's 212 Republicans and 180 Democrats who voted yes.

Now the bill heads to the Senate, where this morning Senate Majority Leader Mitch McConnell (R-KY) announced that the chamber will consider the House package when they return from their two-week Easter Recess. Minority Leader, Harry Reid was quick to point out that his caucus shouldn’t be blamed for the hold-up. He asked that the bill be placed on a fast-track for a vote this morning, but that would have required support of the entire Chamber. Republicans Ben Sasse (NE) and Jeff Sessions (AL) have indicated opposition. However, McConnell is working both sides of the aisle hard and has expressed confidence that the bill will pass after recess “by a very large majority.”

The current SGR is officially set to expire at the end of the month, leaving physicians with a 21% cut in their Medicare reimbursements. However, the Centers for Medicare and Medicaid Services (CMS) noted that it could push back those cuts by another two weeks. CMS told providers that they would hold electronic claims through April 14 and paper claims for 29 days after the date of receipt. That would give the Senate one working day to pass the bill when they return, allowing for one final eleventh-hour SGR miracle in a program that has been filled with them over the past 17 years. That would make for a bittersweet finish for healthcare policy wonks, which have grown to both love and hate the SGR drama. Plus, we at the Washington Update wonder what Congress will do with itself once it finally settles this annual self-imposed crisis. Or maybe we don’t want to know!