WASHINGTON — The House on Thursday passed legislation to give doctors a yearlong reprieve from a looming 24 percent cut in their payments from Medicare.
The bill passed on a surprise voice vote and advanced to the Senate, which hopes to pass it before a Monday deadline. The vote was delayed by an hour amid doubt that the measure could muster the two-thirds vote required under fast-track procedures.
The voice vote was unusual but not unprecedented and was engineered by Majority Leader Eric Cantor, R-Va., with cooperation from senior Democrats such as Minority Leader Nancy Pelosi of California. But House conservatives were not pleased with the maneuver, especially Rep. Louie Gohmert (R-Texas).
“Outrageous,” Gohmert told The Hill after complaining about it to a colleague. “I think it’s outrageous.”
House Republicans had planned to bring up the “doc fix” under a procedure that would require a two-third majority to pass. But they determined they didn’t have the votes required, so with only a few members on the House floor before the vote on Ukraine, Republicans brought the Medicare bill up for a voice vote. Nobody objected, so it passed.
“Bullshit,” said a visibly annoyed Rep. Mick Mulvaney (R-S.C.) to The Hill, as he emerged from the floor. When asked to comment about the upcoming GOP budget, he replied: “I can’t talk about the budget because I’m so pissed about the [doc fix].”It came after several leading Democrats weighed in against the bill, which would “patch” the Medicare fee system for 12 months, saying it 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
Waxman blasted Thursday’s bill as “yet another patch to the Medicare physician payment system.”
“But it should not be that way. We need a permanent fix,” Waxman said.
Pelosi, however, swung behind the legislation.
“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 also contains numerous other health care provisions of interest to doctors, hospitals, drug companies and other health care providers.
Timing in the Senate was uncertain, although there was a lot of pressure to act by a Monday midnight deadline. Otherwise, Medicare would stop processing payments to doctors until the payment fix was enacted.
Aides said Senate Majority Leader Harry Reid, D-Nev., would press to speed the measure through the Senate as early as Thursday, but it would take cooperation from all 100 senators to make that happen.
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.
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.
“The endless cycle of short-term remedies that serve to support a failed policy are no longer acceptable,” the AMA and other groups wrote in a letter to lawmakers.
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., wants to keep working on a permanent solution. He proposes using savings from lower costs for operations in Afghanistan. Republicans are demanding savings from President Barack Obama’s health care law. The resulting impasse has left lawmakers little alternative other than to pass another temporary fix.
“If you just keep going with these temporary solutions, you waste time, you waste money, you threaten the access for seniors to their doctors,” Wyden said. “And the reality is, the patches, as they are called, they’re not free either. You still have to come up with the money.”
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.
The bill also contains a provision benefiting, among others, Amgen Inc., which produces an oral drug for kidney dialysis patients. It would extend through 2024 a controversial provision to allow payments for Sensipar, which is made by Amgen, to be made on top of other payments to treat Medicare patients with kidney disease. It also eases cuts to dialysis providers who have battled with drug companies over the issue.