A cynic’s guide to the galaxy might suggest everyone in healthcare is in it strictly for the money, but it’s tough to tell. After all, what can you do without the stuff? Even FDA and NIH are constantly clamoring for more. Does anyone ever accuse them of having been corrupted by the almighty dollar?

Maybe a few who gripe about FDA user fees, but that’s about it. Following are a couple of stories about the greenback and how these stories might play out between now and the end of the current fiscal year.

Sequestering the sequester

Two bills have surfaced that would exempt FDA user fees from the effect of the sequester, which could drain $40 million in device user fees this year alone. Some might shrug at $40 million, but it’s not exactly chump change when we’re talking about the budget for the Center for Devices and Radiological Health (CDRH).

The net cost for shielding all FDA user fees from the sequester – not just those for CDRH – would be $83 million. Is that enough money to make appropriators wince as they examine the fiscal 2014 budget?

Tough to say, but this movement is much more politically palatable for everyone in Washington than the device tax repeal effort. So this might just fly, especially if there’s a high-profile recall of an FDA-regulated product between now and Oct. 1.

Doc fix thyself

The sustainable growth rate problem has been around for so long that it reportedly has its own office in the Rayburn House office building, but the time for a permanent Medicare Part B doc fix may be nigh. The House Energy and Commerce Committee passed a bill this week that would drop-kick SGR into oblivion, but there are concerns about the $14 billion a year price tag.

Will the money have to come out of another location within Medicare? Democrats will never go for a higher co-pay for Medicare beneficiaries, but a politically palatable threshold for means testing might not create enough loot to cover the hole.

There are rumblings that the doc fix might have better chances if it attaches itself to a debt ceiling deal or the fiscal 2014 budget wagon, but there are a lot of unhappy partisans involved in both discussions.

In either case, it’s the classic high-risk/high-reward scenario. The cost of H.R. 2810 would disappear into a deal for these other fiscal considerations, but Congress and the White House have been throwing down over the next debt ceiling like a couple of professional wrestlers. They’ve avoided fiscal Armageddon in previous debt ceiling clashes, but you never know when all that rancor might blow the roof clean off and take the ceiling with it.

As for the fiscal 2014 budget, when was the last time Congress passed a full suite of budget bills? At least five years and it’s not like Sen. Patty Murray and Rep. Paul Ryan are reading from the same playbook. There’s always tax reform, but it’s tough to see tax reform elbowing ahead of the debt ceiling or the fiscal 2014 budget in the next 50-something days.

This might be a situation in which doctors will have to push H.R. 2810 as a solo act if they want a lasting doc fix by October 1. Otherwise, they’ll have to hope for passage between then and December 31, by which time another one-year patch might look less obnoxious to everyone in Washington than trying to find room for a permanent SGR overwrite.