Boehner, Pelosi See Victories in Fixing Medicare Docs’ Fees


An uncharacteristic joint effort by House Speaker John Boehner and his usual nemesis, Minority Leader Nancy Pelosi, to resolve a gnawing problem about how Medicare pays doctors underscores the political victories each sees in finally sweeping the issue off the deck — if they can.

Boehner, R-Ohio, has taken the unusual step of working with Pelosi toward a compromise both leaders are shopping to lawmakers. This is angering some conservatives with whom he’s repeatedly clashed, including last month when they opposed legislation preventing a Homeland Security Department shutdown and he turned to Pelosi, D-Calif., for votes.

Pelosi knows many liberals are unhappy that the proposal would increase costs for some Medicare beneficiaries, but not for the doctors who would benefit.

Both leaders think the clashes are worthwhile for a proposal that would block an April 1 cut of 21 percent in Medicare fees for physicians, revamp how they’re paid and replenish money for a popular children’s health program.

What’s The Problem?

A 1997 budget deal included a formula limiting physicians’ reimbursements for Medicare patients. Because medical costs have grown faster than envisioned, that formula requires fees that legislators consider unrealistically low and doctors warn could make them abandon Medicare recipients.

Congress has blocked the cuts 17 times since 2002. That has meant recurrent battles over finding budget cuts to replace the lost savings, fights many lawmakers want to end.

What Would Boehner and Pelosi Do?

Top lawmakers introduced legislation Thursday that would abolish the existing doctors’ fee formula and grant physicians 0.5 percent annual increases for five years. Hoping to curb Medicare spending, doctors would be offered financial incentives to charge patients for the quality of care they receive, not the treatments they undergo.

Leaders were still completing the rest of the package as they hunted votes. Lawmakers, lobbyists and aides say it would also finance the Children’s Health Insurance Program, serving around 8 million low-income children annually, for two more years, and provide money for community health centers.

Overall, the changes would cost roughly $200 billion over 10 years. About $140 billion would be financed with bigger federal deficits, the rest split between higher costs for some Medicare recipients and cuts to providers like nursing homes.

The proposal’s fate is unclear, especially in the Senate, a bystander in the process.

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