House approves 'doc fix' in voice vote

The House on Thursday approved legislation by voice vote that prevents a pending cut to Medicare physician rates for another year.

The move, which dodges a 24 percent cut to those rates set to hit on April 1 without congressional action, came after a lengthy delay in which the bill's passage appeared in doubt.

House passage is essentially a take-it-or-leave-it offer to the Senate, which now must decide how to react with just days left before the cut takes effect.

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House Republicans called the bill up under a suspension of House rules, which meant a two-thirds majority was needed for passage, and that 50 to 60 Democrats had to support it. That led to worries all day that the House would not be able to pass it due to Democratic opposition.

Republicans considered pulling the measure as serious questions were raised about whether enough Democrats were there to reach the two-thirds majority. But the voice vote appears to have been a way to avoid a potentially failed vote on a bill that both GOP and Democratic leaders said must pass.

Many Democrats opposed the bill on both process and substance. Democrats cited opposition from the American Medical Association, which said Congress should be pushing for a repeal of the sustainable growth rate (SGR) formula.

The SGR was created in 1997, and calls for cuts to Medicare doctor reimbursement rates that Congress has routinely avoided with temporary patches.

Democrats also complained that the bill was rushed to the floor without giving anyone a chance to understand its contents and that Republicans used the April 1 deadline to force a quick vote on imperfect legislation. But passage was likely aided by Minority Leader Nancy Pelosi (D-Calif.), who said she would vote for the bill despite the process.

"I myself come down on the side of supporting the legislation," she said. Pelosi said she was worried about making seniors uncertain they would be able to see their doctors and said Republicans would only use that uncertainty to attack ObamaCare.

"The Republicans will say this is because of the Affordable Care Act, and I just don't want to give them another opportunity to misrepresent what this is about," she said.

Pelosi said it was up to individual members how to vote on the bill, and several other Democrats said they would oppose it. Rep. Frank Pallone Jr. (D-N.J.), for example, said he would oppose it because it's a step back from the progress both parties were making toward a repeal of the SGR.

"I simply cannot support yet another temporary SGR patch," said Rep. Frank Pallone (D-N.J.). "This bill is bad for seniors and it's bad for doctors.

"It sets back months and months of hard work."

But Republicans noted that the bipartisan bill to repeal the SGR needs to be paid for and that Democrats have not offered any viable way of paying for it.

"We knew all along that we were going to have to have a pay-for," said House Energy and Commerce Committee Chairman Fred Upton (R-Mich.). On the idea of passing a permanent SGR fix without a pay-for, Upton said, "That's not what this House is about."

Earlier this month, the House approved a repeal of the SGR that was paid for with a five-year delay in ObamaCare's individual mandate. But Democrats opposed that bill, forcing the GOP to try another temporary patch.

Pelosi said Democrats support paying for the repeal by using war savings under the Overseas Contingency Operations (OCO) account. Republicans have said this is a "gimmick" because it double counts war savings, an idea Pelosi rejected.

"It wasn't a gimmick when you put it in the Ryan budget," she said.

The bill passed today is technically paid for over a ten-year period, in large part thanks to a decision to move up Medicare sequester cuts from 2025 to 2024. However, that move only shifts costs and does not create any real savings over a longer period of time, which has led to some complaints that the "pay for" is an accounting gimmick.

Still, Republicans said it's the only way forward while the two sides negotiate over how to pay for a repeal.

"We are closer than ever toward reaching that goal," said Rep. Joe Pitts (R-Pa.), the bill's sponsor. "We have an agreement on policy; we need to overcome our differences about a responsible way to pay for those new policies.

"I'm sponsoring this bill today because it is my earnest hope that this is the last patch we will have to pass," he added.