Senate Democrats are softening their opposition to a bipartisan bill likely to pass the House on Thursday that would fix how Medicare pays physicians and extend a children’s health insurance program for two years.
President Barack Obama put pressure on Democrats on Wednesday when he said he looks forward to signing a “good bipartisan bill” to change the Medicare formula and permanently put an end to the “doc fixes” that Congress has passed for years. Endorsements also came from a wide swath of outside groups, such as the Center for American Progress and nearly every physician, hospital and health advocacy group.
Despite some misgivings by conservatives over the price tag, the House is expected to overwhelmingly approve the deal negotiated by House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.). It will then go to the Senate, where it is seen as increasingly likely to pass, although that may not happen until after Congress returns from its
Senate Democrats had two big objections. They wanted to double the House’s two-year extension of the Children’s Health Insurance Program, and they didn’t want to include Hyde Amendment abortion restrictions to the bill’s funding for community health centers. Also, the Senate was not involved in the negotiations, which has frustrated Democrats. Senate Republicans are much more supportive, but some have expressed concern that the package is not fully paid for.
But support has been growing for the unlikely breakthrough. The deal is striking in its historic nature: a bipartisan negotiation between the House’s top Republican and top Democrat on a budget issue — the broken Medicare payment formula — and the extension of CHIP months before its funding deadline in late September. That gives the states — and doctors and hospitals — a lot more certainty as they plan ahead.
House Republican and Democratic aides expressed optimism that it would be widely supported except by hard-line conservatives who oppose deficit spending and progressives who don’t like some of the Medicare changes, which shift some costs to older Americans. The House Rules Committee approved the legislation on a bipartisan voice vote on Wednesday.
After House passage, it is unclear whether Senate Majority Leader Mitch McConnell (R-Ky.) would try to quickly approve the bill after the Senate’s budget debate wrapped up, likely late Thursday or very early Friday morning. But Democrats aren’t likely to go along with a fast-track plan.
A handful of Democratic senators on Wednesday said for the first time that they would support the deal, but they still want a chance to amend it. Some are also worried about approving changes to entitlement programs with scant debate in the predawn hours after a long budget vote-a-rama.
If a vote doesn’t happen this week, lawmakers still have a little time to act after the recess. Without legislation, physicians would see a 21 percent cut in their payments on April 1, but the Centers for Medicare and Medicaid Services could essentially delay that cut until April 14, one day after the Senate returns.
Some, like Sen. John Barrasso of Wyoming, are pushing for a swifter resolution.
“As a doctor, I used to come here to lobby to say why is this thing still getting kicked down the road,” said Barrasso, a member of the Republican leadership. “I think it will pass if we can get it to the floor without having [Minority Leader] Harry Reid once again obstruct the business of the Senate.”
Reid said Tuesday that he wanted to wait until the House passed the bill before deciding whether he supports it.
As recently as last week, many Senate Democrats — including all of those on the Finance Committee — said they were reluctant to support the plan.
But some, such as Sen. Claire McCaskill of Missouri, said they support it. She said Wednesday that she has no concern with the Hyde language since community health centers have been subject to the abortion restrictions for decades.
“We’re getting two years of CHIP, and it was not too long ago that we worried we were even going to get one year,” she said. “So to me, we should reward Speaker Boehner for working with the Democrats and finding a compromise by saying ‘way to go.’”
“I’m fairly confident that we will get this done,” she added.
Sen. Angus King, an independent who caucuses with Democrats, is also inclined to support the bill.
“Getting the doc fix done once and for all is a positive development,” he said. “I wish that it had four years for the CHIP program, but as Mick Jagger once famously said, you don’t always get what you want.”
Sen. Joe Manchin of West Virginia said that he could see himself supporting it, but he too would like to offer amendments, such as a longer extension for CHIP.
“We have a chance to do something that hasn’t been done for 17 years,” he told reporters. When asked whether Democratic leaders should slow down the bill, he said, “I would hope not.”
Other Democrats remain more skeptical. Sens. Barbara Mikulski and Ben Cardin, both of Maryland, told POLITICO that they’re concerned about the bill.
The deal would eliminate the existing Medicare formula for paying physicians, the Sustainable Growth Rate, which both sides agree is flawed. It would implement a new payment policy that is designed to reward quality instead of volume, part of a larger shift in American medicine. To pay for part of the deal, it would establish two changes to entitlement programs: It would require additional means-testing for high-income seniors’ Medicare premiums and eliminate first-dollar coverage in future Medigap policies. Some seniors groups oppose those changes.
Only a fraction of the cost of the package is paid for in the first decade. The Congressional Budget Office said Wednesday that it would add $141 billion to the deficit in the next decade — but that Congress’s current patch-after-patch trajectory would cost almost as much. The agency said savings from the structural reforms to Medicare would increase in later years but that a solid estimate was nearly impossible to measure that far in the future, given how fast U.S. health care is changing.
“It’s my hope that after tomorrow we won’t actually have to talk about [the SGR] anymore,” said Rep. Michael Burgess, one of the bill’s sponsors, “and that’s actually the day that I live for.”
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