Congress may still be in session, but the government shutdown and interrelated issue of a near-term action to increase the nation's borrowing authority or debt limit are throwing a wrench into the fall legislative calendar and dashing hopes that some major health issues will be resolved promptly.

As we've moved into October, little noticeable progress has occurred on efforts to replace the Sustainable Growth Rate (SGR) formula used to pay physicians for treating Medicare beneficiaries. Long a bane to physicians and their lobbyists, Congress has acted repeatedly, often late in the year, to replace scheduled Medicare cuts to providers with flat funding or modest bumps.

Tired of simply patching the problem every year and buoyed by updated cost estimates that a permanent repeal and replacement of SGR would be less-expensive than previously estimated, a number of leaders in Congress have been working diligently toward this end. The House Energy & Commerce Committee passed its version of the bill in late June, but neither the House Ways & Means nor the Senate Finance Committees have released their versions of the bill.

Action by these two committees is particularly important since while Energy & Commerce put forward a proposed five-year transition to a new payment system that moves toward a value-based payment system, that legislation does not specify where money to cover this reform will come from. 

Beyond SGR, action on a number of other health related bills has been slowed by the shutdown. For example, the Senate HELP Committee was scheduled to mark up a number of bills on October 2, including a long-delayed reauthorization of Children's Hospital Graduate Medical Education (CHGME), which helps pay for the cost of training doctors. Delayed for years due to a debate about how much of the funds should go to children's psychiatric hospitals, an agreement was reached in late September, but the shelved markup delays the timeline.

The timeframe on a bill that would tighten federal oversight of compounding pharmacies and implement a national system for tracing pharmaceutical products throughout the supply chain is also delayed. A bipartisan bill negotiated with the Senate cleared the House on the weekend before the government shutdown and must now make it through the Senate. Though many are frustrated with the delay, the bipartisan agreement is expected to pass the Senate soon.

Of course, given the very fluid nature of the situation in Washington and the very real potential that the shutdown and debt ceiling are addressed in tandem, all stakeholders must be paying close attention, particularly if their issue or issues could be used as a potential offset to pay for a package. And, if Congress ends up taking only short-term actions, such as funding the government until mid-December or allowing the debt ceiling to increase marginally, stakeholders could find themselves in a very familiar place shortly before Christmas.