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CAPITOL PERSPECTIVES and that CMS is behind on activities that cross "the core exchange functional areas." Meanwhile, in a glimmer of hope to end the paralysis, the Energy & Commerce Committee came together this summer and reported out a bipartisan bill to repeal the flawed Medicare physician payment formula, the "SGR." That formula has been overridden more than 15 times in the past 10 years in stop-gap fashion where Congress kicked the can down the road without finding a permanent solution to the pending 25% payment cuts or reforming a fee-for-service system that rewards volume instead of quality. It would be a real achievement to permanently repeal this unworkable formula and set the system on a path focused on patient outcomes. But how is Congress going to find the $140 billion to $160 billion necessary to fund this change over the 10-year budget window? That's where bipartisan consensus is likely to break down. A little-discussed option would be to delay implementation of Obamacare spending for one year. ment of the Obama Administration gets implemented properly. (Even the Obamacare architects stipulate that the bill that became law was never intended to be the final product, but a bill to get the Senate to conference. The 2010 election of Scott Brown in Massachusetts destroyed the Democrats' 60-vote control of the Senate chamber and compelled the House to enact the Senate bill in its entirety.) But a delay requires Democrats to take their foot off the gas and acknowledge that time is needed to make necessary changes. There is a substantial faction of the Republican party ... that would like to either repeal Obamacare in its entirety or require the entire statute be implemented precisely as written and watch with glee as the Democrats' law fails to deliver half of its promises at twice the cost. • • While the Medicaid expansion and new subsidies for individuals in the exchange cost only $49 billion in 2014, Congress could grab $170 billion of savings over the 10-year budget window because that represents Obamacare spending in 2023 — the last year in the budget window — which would now be pushed outside the window. That is more than enough resources to clean up SGR and other temporary policies that Congress has failed to fundamentally address. The one-year delay would give the administration valuable time to ensure that the signature domestic achieve- • Republicans would agree to technical changes to make Obamacare implementation more workable. Those fixated on full repeal could view a one-year delay as a repeal-on-installment-plan as it blocks spending in 2014. • To attract Republican support, Democrats should agree to a policy win for the Republicans, such as repealing the reviled Independent Payment Advisory Board, which can rewrite Medicare payment and coverage policy without congressional input when certain spending triggers are hit. • • Republicans should also reject the Heritage Foundation's assertion that SGR reform should not be linked to "pay for performance" for physicians who meet quality metrics developed by physician medical societies and implemented by Medicare. Far right skepticism of best practices developed by the physician community is unfounded. For any of these sensible changes to take place, Republicans and Democrats need to work together across the aisle and ignore the dogmatic radicals of their respective bases calling for outright repeal on one side and immediate, unaltered implementation on the other. John McManus is president and founder of The McManus Group, a consulting firm specializing in strategic policy and political counsel and advocacy for healthcare clients with issues before Congress and the administration. Prior to founding his firm, McManus served Chairman Bill Thomas as the staff director of the Ways and Means Health Subcommittee, where he led the policy development, negotiations, and drafting of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Before working for Chairman Thomas, McManus worked for Eli Lilly & Company as a senior associate and for the Maryland House of Delegates as a research analyst. He earned his Master of Public Policy from Duke University and Bachelor of Arts from Washington and Lee University. He can be reached at jmcmanus@mcmanusgrp.com. 12 LifeScienceLeader.com September 2013