Congress locks in higher Medicare pay for Hawaii doctors, no budget cuts required
S. 1624 — PATCH Act · Filed by Brian Schatz (D-HI) · 1 cosponsor · Introduced May 6, 2025 · Referred to committee
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What it does
This bill amends Medicare's physician payment formula to guarantee that Hawaii's 'work geographic index'—a multiplier that adjusts doctor payments based on regional cost of living—will never fall below 1.5, effective January 1, 2026. Currently, Hawaii's index can drop lower, reducing what Medicare pays physicians there. The bill locks in a floor, meaning Hawaii doctors will receive higher Medicare reimbursements than the formula would otherwise calculate, and explicitly states this change will NOT be budget-neutral (i.e., Medicare will spend more money).
Why we flagged it
The bill's sole operative mechanism is establishing a geographic payment floor for a specific state's physicians under Medicare's fee-for-service formula. It is a targeted reimbursement adjustment, not a broader healthcare reform or systemic change.
What the text implies
- The explicit rejection of budget neutrality signals that this cost will increase Medicare spending without corresponding reductions elsewhere, potentially affecting the program's solvency trajectory or crowding out other payment adjustments.
- By locking Hawaii's index at 1.5, the bill may create pressure for similar geographic floors in other high-cost or underserved regions, establishing a precedent for state-specific carve-outs in the Medicare payment formula.
The full analysis lists 3 implications of this text.
Who stands to gain
Physicians and medical practices in Hawaii; Medicare Advantage plans operating in Hawaii (if they use Medicare fee-for-service benchmarks)