Momentum building in Congress for $174 billion Medicare fix

Momentum is building in Congress for a proposal that would abolish Medicare cuts, top Republicans said Thursday, despite the emerging battle over the $174 billion price tag.

Optimism has been growing this week that Congress could finally reach its long-sought goal of ending the automatic cuts to doctors under Medicare, which come through what is known as the Sustainable Growth Rate (SGR).

The package being discussed by House leaders in both parties would partially pay for the cost of the $174 billion fix, sources say.

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The legislation got a lift Thursday from Senate Finance Committee Chairman Orrin HatchOrrin HatchSenate GOP: National museum should include Clarence Thomas Mnuchin's former bank comes under scrutiny Trump’s economic team taking shape MORE (R-Utah). Asked if the measure needed to be fully paid for, he said, "I'd do it no matter what it takes.”

"It's kind of a phony bookkeeping thing anyway,” Hatch said of Congress’s ritual of putting off the cuts through what is known as a “doc fix.”

Rep. John FlemingJohn FlemingGOP seeks to make it 52 Louisiana Senate race heads to runoff Senate TV spending crosses 0M mark MORE (R-La.), co-chairman of the GOP Doctors Caucus, said in an interview Thursday that he strongly believes the bill will clear the House this spring. Still, he acknowledged that it would be a struggle to convince some fiscal conservatives to pass a bill that adds to the deficit.

“Many of the party’s fiscal conservatives say we should find a way to pay for all of it, but then again I don’t think they understand, as we do as doctors, that that puts our colleagues into a very difficult situation,” Fleming said.

Fleming said he believes the party's best option is to slash entitlement spending — starting with creating work requirements for welfare and by reforming food stamps.

House Republican leadership offices have been tight-lipped about the plan. Michael Steel, a spokesman for Speaker John BoehnerJohn BoehnerRyan delays committee assignments until 2017 Lobbying World 'Ready for Michelle' PACs urge 2020 run MORE (R-Ohio), declined to comment Thursday on any of the proposals under consideration.

While multiple healthcare lobbyists on Thursday said the House is close to a deal, conservative groups such as Club for Growth and Heritage Action are vowing to oppose any measure that is not fully paid for.

“Americans didn’t hand Republicans a historic House majority to engage in more deficit spending and budget gimmickry,” said Heritage Action spokesman Dan Holler. “Any deal that only offsets a fraction of the cost, like the one currently being discussed behind closed doors and leaked to the press, is a non-starter for conservatives.”

Fleming said he believed Democratic support would help carry the bill to passage and eventually to President Obama’s desk, where he said he is confident it will become law. A spokeswoman for the White House declined to comment Thursday.

“Frankly, I think Democrats would support it in high numbers, and I think you’d get it passed,” Fleming said.

If the legislation reaches the floor, it will put House Minority Leader Nancy Pelosi (D-Calif.) into the position of dealmaker. Democrats will likely use the opening to push for an extension of the Children’s Health Insurance Program or for a pay bump for Medicaid doctors.

A House Democratic aide said that the package could include CHIP funding and supplemental Medicare payments known as “extenders,” which would push the price of the bill over $200 billion, though it would be partially offset.

With time running out ahead of the March 31 deadline, one option being considered is to buy time for negotiations by passing a stopgap bill that would last only a couple of weeks.

Asked if a permanent fix could get through by the end of March, Hatch replied, “I can’t say.”

Fleming’s co-leader of the Doctors Caucus, Rep. Phil Roe (R-Tenn.), on Thursday said “a short-term bridge is only acceptable if it helps get a permanent solution through the House and Senate and on to the president’s desk.”

“I am 100 percent committed to finding a permanent solution for SGR and believe that now is the best time to get this done,” Roe wrote in a statement Thursday.

Members of the GOP Doctors Caucus said the proposal to end the Medicare cuts caught them by surprise, though many had met with House leadership months ago to push the effort. House and Senate aides across Capitol Hill also said they had been left out of the talks until this week.

Fleming said he and others sat down with BoehnerJohn BoehnerRyan delays committee assignments until 2017 Lobbying World 'Ready for Michelle' PACs urge 2020 run MORE shortly after the midterm elections, which they realized had given them their first chance to actually pass their legislation. But he said he had emerged “pessimistic” from the meeting as he heard Boehner repeatedly object to the members’ calls for the legislation because they lacked specific ideas for offsetting the costs.

“We left pretty much thinking this was going to be the same old situation when we pass another six-month patch, so lo and behold I was surprised,” Fleming said.

After learning about the developing proposal through news reports on Wednesday, Fleming asked House Majority Whip Steve Scalise (R-La.) on Thursday how the leadership planned to fund the bill.

“I asked him, ‘What are the proposed pay-fors?’” Fleming said. “He said they’re still working on that. That’s leadership talk for, ‘It’s none of your business, we’ll tell you when we get around to it.’ ”