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Democrats in Congress want to extend this temporary piece of Obamacare

Christopher Furlong/Getty Images News

A pay bump for doctors is slated to quietly phase out in four months — but not if Democratic legislators can help it.

Obamacare gave primary care doctors a pay bump for seeing Medicaid enrollees, using federal dollars to pay them the same rate they get for seeing Medicare patients (the latter rate is typically much higher).

That began in 2013, and was meant to incentivize physicians to keep seeing Medicaid patients as the program expanded to cover millions more Americans. But the pay bump is temporary and, under current law, slated to end in December 2014 — unless a handful of Democratic legislators get their way.

Efforts to extend the the pay bump emerge

House Representatives Waxman (D-Calif.) and Pallone (D-N.J.) have tucked a provision extending the increased payments through 2019 into a much larger health care bill they introduced at the end of July. Their legislation would extend the pay increase to other providers, including neurologists and psychiatrists.

Two other senators have proposed a more modest two-year extension. Their bill would also broaden the pay bump to include nurse practitioners, physician assistants, obstetricians/gynecologists, and nurse-midwives.

Meanwhile, some states have already offered to chip in their own funds to extend the pay bump. Six states — Alabama, Colorado Iowa, Maryland, Mississippi, and New Mexico — plan to use their own money, after 2014, to keep rates level. But elsewhere in the country, providers are facing cuts to reimbursement rates as the Medicaid population swells.

Is this the new "doc-fix"?

For people who follow health policy closely, this takes on a familiar cadence. For over a decade, Congress has used a Medicare funding formula that perennially falls short of keeping doctor salaries steady. So each year — sometimes, multiple times a year — Congress passes legislative patches to make up the difference.

If providers think that Medicaid's new payment rates should be the "new normal" — and if Congress agrees — we could see a similar dance every few years.

There are legitimate arguments to be made that Medicaid should pay doctors and other providers more than they currently do. But facing that reality means figuring out who will pay for higher reimbursements, and which providers will benefit.