Doubts rising about 'doc fix' vote

House legislation to prevent a looming 24-percent pay cut to Medicare doctors appeared in jeopardy of being voted down on Thursday after major physician groups came out against it. 

The turmoil strains an agreement between House and Senate leaders to pass a one-year “doc fix” this week in the absence of agreement about how to pay to permanently prevent the cuts.

A wide coalition of medical groups voiced “strong opposition” to the one-year bill on Thursday, backing up an earlier call by the American Medical Association (AMA) for lawmakers to vote against the measure. 

“Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary provider payment reductions to maintain a corrosive policy that essentially every member of Congress says should be scrapped,” the groups wrote in a letter to House leaders. 

The AMA and its peers are closer than ever to achieving repeal of the sustainable growth rate (SGR), a formula that orders regular, deep cuts to Medicare doctors that Congress blocked for a decade. 

But lawmakers have been unable to agree on how to pay for the reform, which is estimated to cost $150 to $180 billion over 10 years. Any package would likely come with cuts to healthcare providers, not an easy vote for any member in an election year. 

The Obama administration had not weighed in as of Thursday morning. The White House supports long-term reform but previously opposed House passage of permanent “doc fix” legislation because the measure also delayed ObamaCare’s individual mandate. 

House lawmakers were debating the one-year bill as of Thursday morning, and in a show of confidence, House Minority Leader Nancy Pelosi (D-Calif.) said she would support the measure in order to avoid uncertainty for seniors on Medicare. 

But she also criticized GOP leaders for not pressing forward on legislation that would permanently end the payment problem.

“This is the wrong way to go,” Pelosi said during a press briefing in the Capitol. “However, you know as I that if this does not pass, and docs do not get the SGR, that seniors may be turned away from their Medicare physician. And you know what the Republicans will say. They'll say that this is all because of the Affordable Care Act. … And I just don't want to give them another [attack line].

“If the Affordable Care Act never existed,” she added, “we would still have to fix the SGR.”

The comments came just moments before a scheduled House vote on a GOP bill to increase Medicare physician payments for one year – a vote that was postponed as GOP leaders appeared not to have the support needed to pass their measure under suspension rules. Bills placed on the suspension calendar can move much more quickly to the floor, but require a two-thirds majority to pass once they get there.

Pelosi said the Republicans likely put the measure under suspension rules because they lacked the 218 GOP votes to pass it by regular order. When Democratic opposition seemed to be mounting Thursday morning, the Republicans postponed the vote.

Across the Capitol, Senate Finance Committee Chairman Ron Wyden (D-Ore.) has been pushing a permanent SGR fix to be offset by controversial savings from the war in Afghanistan – money that was appropriated but won't spent because of the drawdown in U.S. troops there. But House GOP leaders have rejected that approach, saying it relies on a budget gimmick – an argument Pelosi was quick to decry Thursday.

"They say, 'OCO [the war savings], it's a gimmick,'" she said. "They voted for it in the Ryan budget. It wasn't a gimmick then, but it seems to be a gimmick now."

Still, Pelosi said she'll back the bill as a lesser of evils.

"I don't like it, but it serves a purpose," she said, emphasizing that Democratic leaders will not whip their members.

That view puts her at odds with other Democratic leaders, including Assistant Leader James Clyburn (S.C.) and Rep. Frank Pallone (N.J.), senior Democrat on the Energy and Commerce Committee's health subpanel, who will vote no. 

It is unclear how the Senate will proceed. Senate Majority Leader Harry Reid (D-Nev.) is said to favor a short-term approach that will protect vulnerable Democrats from a vote on massive healthcare cuts.

This story was updated at 12:11 p.m.

Mike Lillis contributed to this story.