Senate overwhelmingly approves ‘doc fix’

The Senate on Tuesday overwhelmingly approved a $200 billion Medicare reform package that will end a two-decade-old headache for Congress known as the “doc fix.”
The rare bipartisan bill, which passed 92-8, marks one of the biggest achievements yet from the newly GOP-controlled Congress. It will now head to President Obama, who has promised to sign the bill.
Obama praised the doc fix bill and said he “will be proud to sign it into law.”
“It’s a milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their health care needs,” he said in a statement. 
“It’s another reminder of a new Republican Congress that’s back to work,” Senate Majority Leader Mitch McConnell said in a statement.
{mosads}The nearly three-hour voting period began shortly after 7 p.m. on Tuesday, just before a key deadline that would have triggered double-digit cuts to Medicare doctors. The final votes were cast just before 10 p.m.
Attempts to schedule a vote had been slowed to a halt by the half-dozen amendments floated by both parties.
“The reason we’ve been not moving forward more quickly, is first of all, we had to get some of the holds lifted,” Senate Majority Leader Harry Reid (D-Nev.) said on the floor before the votes. 
Senators at one point asked the Obama administration whether they could wait until noon Wednesday without triggering the cuts, but ultimately decided to forge ahead Tuesday night.
The Senate eventually voted down all six amendments – three from each party – that had been crucial to bringing the legislation to a vote.
An amendment from Sen. Ben Cardin (D-Md.) to repeal Medicare’s limits on physical therapy coverage had caused concern throughout the day because it appeared that it could have enough votes to pass. Any changes to the bill would have sent it back to the House, which would have taken more time and triggered the 21 percent cut to doctor payments.
But the amendment ultimately failed to reach the 60-vote threshold, getting 58 votes.
The nearly 300-page bill repeals automatic cuts to doctors’ payments under Medicare known as the Sustainable Growth Rate (SGR), ending Congress’s ritual of temporarily putting off the cuts.
“This has been a long ordeal that a lot of us have worked on for a long time,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said ahead of the vote, calling it a “major, major accomplishment.”
Before the vote, McConnell acknowledged concerns from some in his party that the bill was not fully paid for, but said he did not want the amendments to pass so that the measure could move forward.
“Like any large bill, it’s a mixed bag in some respects,” McConnell said.
But he pointed to means-testing measures making wealthier Medicare beneficiaries pay more as a long-sought Republican goal.
“That issue alone commends the bill, not to mention the fact that on 17 occasions, we’ve gone through these short-term fixes,” he said.
Speaker John Boehner (R-Ohio), who quietly started negotiations on the bill starting early this year, has similarly praised the bill as “the first real entitlement reform in two decades.”
The House-approved bill had been met with some resistance from a core group of fiscal conservatives in the Senate who objected that it was not fully paid for.
To win support from those conservatives on the overall bill, leadership allowed a vote on an amendment from Sen. Mike Lee (R-Utah) that would have forced lawmakers to fully pay for the bill. The measure was defeated, 58-42.
The amendment would have undone a carefully crafted deal between Boehner and House Democratic Leader Nancy Pelosi (D-Calif.) about how to pay for the bill. Even with two-thirds of the bill’s costs not offset, the House overwhelmingly approved the bill before leaving town for a two-week recess.
Senators of both parties took longer to warm up to the bill, with some members continuing to voice concerns this week that they had been left out of the negotiations.
“This bill would have been stronger if this body had been involved in all of the negotiations,” Sen. Ron Wyden (D-Ore.) said on the Senate floor on Tuesday.
Eight senators opposed the bill, including Sens. Ted Cruz (R-Texas) and Marco Rubio (R-Florida) who are both seeking the presidency in 2016. They were joined by Sens. Lee, David Perdue (R-Georgia), Ben Sasse (R-Neb.), Tim Scott (R-S.C.), Jeff Sessions (R-Ala.) and Richard Shelby (R-Ala). 
Sen. Rand Paul (R-Ky.), another 2016 candidate, and Sen. Lindsey Graham (R-S.C.), who is also considering a run, voted to support the bill.  
Disputes over how to pay for the “doc fix” have dogged Congress and derailed the legislation under GOP and Democratic-controlled majorities. Ultimately, lawmakers have been forced to make last-minute deals to avert a meltdown of the healthcare system 17 times since 1997.
House leaders again used the Medicare payment deadline as a way to advance the vote this year, with some critics arguing it left little time for negotiation. Sessions, one of the most vocal proponents of the Lee amendment, on Tuesday criticized GOP leaders for bringing up the legislation on the eve of the crucial deadline
“Too often, a bill that’s not sound financially is moved at the very last minute,” Sessions said Tuesday.
The bill will cost $214 billion over 10 years, with $73 billion of that cost offset with spending cuts or new revenue, according to the Congressional Budget Office (CBO). The bill includes reforms to transition Medicare’s payment system from incentivizing quantity to quality in care and is likely to produce small savings for the government over time, according to the CBO.
However, Sessions and conservative groups like the Heritage Foundation pointed out that the Medicare agency’s actuary warned last week that Congress could need to pass more legislation down the road to ensure that Medicare doctors do not lose out in the second decade of the law.
To help pay for the measure, the bill makes beneficiaries making more than $133,000 a year pay a higher share of premium costs, a provision McConnell praised but some Democrats opposed.
Democrats had also objected that the bill includes just two years of funding for the Children’s Health Insurance Program. An amendment to increase it to four years of funding failed on Tuesday. 
– Jordain Carney contributed.
– Updated at 10:40 p.m.
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