Legislation to give doctors a year-long reprieve from a looming 24 percent cut in their payments from Medicare overcame turbulence in the House on Thursday, and appears on track to clear the Senate this week, possibly just hours before a Monday midnight deadline.
The bill passed the House Thursday on a surprise voice vote after an hour-long delay signaled GOP leaders were having difficulty mustering the two-thirds vote to pass the bill under fast-track procedures. Prominent Democrats withheld support, as did a host of rank-and-file Republicans, which led top leaders in both parties to call off a roll call vote and ease the measure through with a wink and a nod.
The vote was engineered by Majority Leader Eric Cantor, R-Va., with cooperation from top Democrats, particularly Minority Leader Nancy Pelosi of California.
It came after several leading Democrats weighed in against the bill, which would “patch” the Medicare fee system for 12 months. They complained that the temporary measure would set back efforts to find a permanent fix for the program’s flawed Medicare payment formula, which has bedeviled lawmakers for more than a decade. There is widespread support for legislation to permanently solve the problem, but no agreement on how to pay for it.
The measure represents the 17th time Congress has stepped in with a temporary fix to a poorly designed Medicare fee formula that dates to a 1997 budget law. The House vote came after efforts to permanently fix the formula appeared to have fizzled. Democrats such as Reps. Frank Pallone of New Jersey and Henry Waxman of California said they would oppose the measure because it would hurt the effort to find a permanent solution to the problem
“For 10 years we have been trying to fix the sustainable growth rate in Medicare, and for 10 years we have kicked the can down the road, with 17 different short term patches,” said Rep. Jim McDermott, D-Wash.
Pelosi, however, swung behind the legislation, which also had strong support from Senate Majority Leader Harry Reid of Nevada, President Barack Obama’s most powerful ally on Capitol Hill.
“The simple fact is that the clock is ticking, and on March 31st, it’s bad news for seniors and for the doctors who treat them in the Medicare program,” Pelosi said.
The heavily lobbied legislation contains numerous other health care provisions of interest to doctors, hospitals, drug companies and other health care providers.
Hopes for a Senate vote on Thursday faded, and were replaced with a plan to vote late Monday afternoon. If Congress blows the deadline, Medicare would stop processing payments to doctors until the payment fix is enacted.
There is widespread support for bipartisan legislation to repair, once and for all, the broken Medicare formula, but there is no agreement on how to bear the 10-year, $140 billion cost. Democrats want to use savings from the troop drawdown in Afghanistan; Republicans insist on wringing at least some money from the Affordable Care Act. The resulting impasse has left lawmakers little alternative other than to pass another temporary fix.
Thursday’s measure confronted lawmakers and leaders with a difficult choice — whether to vote for a measure they didn’t like or risk an interruption in Medicare payments.
The powerful American Medical Association and a host of other health care provider groups weighed in against the measure, saying it would undermine the drive for a permanent solution.
However, Rep. Joe Pitts, R-Pa., said, “a vote ‘no’ today is a vote against seniors. We are not voting for the AMA today.”
New Senate Finance Committee Chairman Ron Wyden, D-Ore., vowed to keep working on a permanent solution.
Thursday’s drama was resolved after a lengthy meeting between Cantor and lawmakers such as John Fleming, R-La., a doctor who opposed the legislation.
“Basically, everybody agreed to not oppose it,” Fleming said. Asked why he didn’t block the measure, he said, “If I’d done that, you’d have most doctors across America see an immediate, 24 percent, off-the-cliff cut in their incomes,” which would have meant “doctors across the board would have stopped seeing Medicare patients.”
The measure blends $15 billion to address Medicare physicians’ payments with about $5 billion more for a variety of other expiring health care provisions, like higher Medicare payments to rural hospitals and for ambulance rides in rural areas. On Wednesday night, the Congressional Budget Office released an analysis that said the bill would increase spending by $14 billion over the next two years, and that almost $11 billion of the legislation’s savings wouldn’t accrue until 2024.
Savings come from curbs on payments to hospitals that care for a large share of indigent patients and by employing a gimmick regarding automatic Medicare cuts that aren’t due for another 10 years.