The House on Thursday advanced a bill to delay enforcement of the individual mandate under ObamaCare for five years, amid Democratic complaints that the bill would raise insurance premiums and leave millions uninsured.

In a 228-184 vote, members passed a rule allowing floor consideration of the bill, which the House is expected to pass Friday. The rule was supported by three Democrats.


The legislation, H.R. 4015, started as a bill to repeal scheduled cuts to Medicare physicians — members of both parties support this "doc fix" proposal. However, Republicans have added language to pay for the doc fix by delaying the individual mandate penalties, a change that many Democrats were expected to oppose.

That language took the form of an amendment from House Ways and Means Committee Chairman Dave Camp (R-Mich). Camp's amendment was added to the bill upon passage of the rule, which led to Democratic complaints on the floor.

"In this case, the Republicans are presumably to embarrassed about their pay-for … that they are slipping it into the rule, in what's called the 'deem-and-pass' language, or what is characterized by some as the 'demon pass' language," said Rep. Jared Polis (D-Colo.).

Republicans downplayed the idea of delaying enforcement of the mandate, and cast the bill as a way out of the endless threat of cuts to doctors under the sustainable growth rate (SGR) formula. Congress has routinely dodged those cuts, but Rep. Michael Burgess (R-Texas) said the bill should be seen as a permanent way out of this problem.

"This bill repeals the sustainable growth rate formula, avoiding potentially devastating across-the-board cuts slated for 2014, and does so at a cost far lower than what Congress has already spent or would likely spend over the next 10 years time," he said.

On Wednesday, the Congressional Budget Office released a score that said the doc fix portion of the bill would cost $138 billion, and ending enforcement of the individual mandate would save $170 billion over 10 years.

Dropping enforcing of the mandate would mean the government receives no penalties from the uninsured, but it would also mean the government spends less on subsidies to help people buy insurance. The CBO also said the bill would lead to 13 million more uninsured people in 2018, and that insurance premiums would increase.

The original bill on the SGR had 48 Democratic co-sponsors, but there were signs during Thursday's debate that much of that Democratic support would dissipate because of the addition of the individual mandate language. Rep. Ron Kind (D-Wis.) is a current co-sponsor of H.R. 4015, and while he didn't say he would vote against the bill, he warned that the mandate language means it won't go anywhere.

"The problem that we have … is how they're going to pay for it," Kind said. "It is this itch that they have to scratch over and over again called the Affordable Care Act, or so-called ObamaCare.

"We'll go through this ruse yet again tomorrow. It'll probably be along partisan-line votes, knowing that it's not going to advance anywhere in the Senate, nor would the President embrace this type of pay-for."

Last week, Minority Whip Steny Hoyer (D-Md.) warned that tying the two issues together runs the risk of failing to get the doc fix passed by the end of this month, when cuts to physician payments are scheduled. Kind predicted that once this becomes clear, the two parties will have to start talking to each other on ways to find an acceptable pay-for to pass the doc fix.