GOP leaders pressed lone 'yes' vote Burgess to reject Medicare bill

The lone House Republican who voted for the Medicare physician payment bill on Thursday said he did so because it has little chance of becoming law.

Rep. Michael Burgess (R-Texas) is a physician and longtime advocate for permanently solving the annual legislative headache of increasing the amount of money reimbursed to doctors treating Medicare patients.

He said that even though he opposed the way House Democrats are seeking to fix the formula, his vote for the White House-endorsed bill was “symbolic.”

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“I think it is very unlikely that today’s bill will ever become law, since the Senate has already soundly rejected a similar plan. Because of this, today’s vote is largely symbolic,” he wrote in a statement released after the House passed the $210 billion measure, 243-183.

Minutes before grabbing and signing the green “aye” voting card in the well of the House, Burgess was surrounded by Chief Deputy Whip Kevin McCarthy (R-Calif.), Rep. Mary Bono Mack (R-Calif.) and Rep. Paul Broun (R-Ga.).

But the former obstetrician broke from the pack and signed his voting card in favor of the measure some Republicans were calling a "political charade."

Following the vote, GOP Whip Eric Cantor (Va.) had words with the Texas legislator, a scene that unfolded below reporters sitting in the press gallery above the chamber.

“What about me?” Burgess was overheard saying in the back-and-forth with Cantor, who graciously nodded, then, after a few minutes, turned and walked toward another group of lawmakers that included McCarthy.

Burgess likened his position to that of a lawmaker who served in the military being asked to vote against a defense bill, according to a source familiar with the conversation. Burgess felt that leadership never fully communicated the overall strategy of voting against a bill that was destined to fail.

After the 2008 elections, Burgess ran for a leadership post, but fell short in his bid for policy chairman to Rep. Thaddeus McCotter (R-Mich.).

Eleven Democrats crossed the aisle to vote against the measure that would correct what both parties agreed was a “flawed formula” established in the Balanced Budget Act of 1997 (BBA) for reimbursing physicians with Medicare patients.

House Democratic leaders have touted their pay-as-you-go rules since winning the majority of the lower chamber, but the physician bill is not paid for. 

Republicans seized on that issue, pointing out that President Barack Obama said this week in China that there should not be any more deficit spending.

“It exacerbates the problem of the fiscal recklessness of the majority party. As a physician I know, with every fiber of my being, that the doctors of this land are sick and tired of being played for fools,” Rep. Tom Price (R-Ga.) said on the House floor.

Democrats blamed Republicans for creating the precarious situation because instead of making a permanent fix to the problem, they would implement temporary annual payment adjustments.

“Most of the costs associated with this bill are the result of stopping the gimmicks Republicans used for years and cleaning up the mess created by those gimmicks. The first step to getting out of debt is being honest about the debt we are in,” Majority Leader Steny Hoyer (D-Md.) said during the debate on the bill.

When the Republicans controlled the House, they did not offset the costs of the annual Medicare payment fixes with cuts in spending that took place immediately, instead opting to make cuts in future budgets.

Republicans conceded that their party was to blame for not solving the problem created by the BBA, but refused to let up their pressure on Democrats for making a huge exception to their pay-as-you-go budgetary rules.

House Democratic leaders originally included the doctor payment bill in their healthcare reform proposal. But they opted to remove it after critics noted that the Democrats were about to break Obama’s pledge to offset all costs of healthcare reform.

The American Medical Association (AMA) endorsed the House Democrats’ reform bill after securing a promise from Democratic leaders to permanently fix the Medicare payment formula.

“No one here on the floor has any illusions about what’s going on. This is a bill to appease a political deal that was struck, not to actually fix the doc problem, because this bill is not going in the law," Budget Committee ranking Republican Paul Ryan (Wis.) told The Hill.

Despite the intense lobbying from AMA and other physicians groups, Cantor and his whip team succeeded in convincing all other GOP members to reject the bill.

Some Republicans in both the House and the Senate have struggled on how to vote for the pricey doctor payment bill. They want to keep doctors in their districts and states pleased, but they are also wary of adding to the federal deficit.

According to GOP leadership aides, Cantor faced an uphill battle since learning on Tuesday that at least 70 GOP lawmakers were undecided or intended to vote for the bill. But, leaders decided to press for a solid "no" vote because they felt that it was more important to show fiscal discipline.

Before the vote, House GOP leaders held a closed-door conference meeting to rally opposition to the bill, noting it has little chance of clearing the Senate.

According to lawmakers at the conference meeting, nine of the 13 members in the GOP Doctors Caucus struggled on how to vote for the measure, which would prevent a 21 percent decrease in physician reimbursement rates from going into effect in January.

At least one GOP doctor, Rep. Phil Roe (R-Tenn.), was undecided until he cast his vote against the bill on the floor Thursday afternoon.

As a deficit hawk, he told The Hill that the Democratic proposal was difficult to fathom because it was not paid for and “goes against everything [he] stands for.”

Roe, an OB/GYN, worried, however, that without the temporary fix, it would result in “decreased access for patient care.”

It “was the hardest vote” that Roe, a freshman, has had to take since coming to Congress, he said.

Republicans tried to offer a proposal that would have fixed the formula for four years by using money saved with tort reform to pay for their alternative. Democrats blocked that effort on a procedural motion.

And on a strictly party-line vote, Democrats killed a GOP amendment that would have created a two-year fix.

Two hours before debate started on the floor, Ryan received a letter from the Congressional Budget Office (CBO) confirming that when combined with the House-passed healthcare reform bill, the “doc fix” would increase healthcare costs and the deficit.

“CBO says you combine the two bills together, then it does increase the deficit and it does make healthcare costs go up in the out years,” Ryan said.

Democrats had already started plotting campaign ads against Republicans who opposed the doc fix on Thursday afternoon.

Ryan Rudominer, Democratic Congressional Campaign Committee national press secretary, said, “If Eric Cantor and House Republicans have their way, America’s seniors and people with disabilities would be turned away from the doctors they know and trust and forced to go out and find new ones. Times are tough and seniors are already dealing with high prescription-drug costs; the last thing they need is for House Republicans to increase their healthcare costs and anxiety by allowing Medicare to cut payments to their doctor.”

Some Democrats who could face challenging elections next year voted with the GOP.

The 11 Democrats who rejected the bill were Reps. Brian Baird (Wash.), Dan Boren (Ind.), Jim Cooper (Tenn.), Chet Edwards (Texas), Stephanie Herseth Sandlin (S.D.), Suzanne Kosmas (Fla.), Daniel Lipinski (Ill.), Mike McMahon (N.Y.), Collin Peterson (Minn.), Adam Smith (Wash.) and Gene Taylor (Miss.).

Of these, Republicans are targeting Edwards, Herseth Sandlin, Kosmas and McMahon in the 2010 cycle.