House Votes To Cancel Medicare Pay Cuts For Doctors
The House did Thursday what the Senate couldn't do a month ago: It passed a bill to cancel a 21 percent pay cut for doctors who treat Medicare patients that's set to take effect Jan. 1 without legislative intervention.
Passage of the bill was by a near party-line vote of 243-184, and came over the vehement objections of Republicans, who complained bitterly that the measure's $210 billion, 10-year cost was not offset by other spending cuts or tax increases.
"The truth is spending policies of this Congress and this administration are a fiscal time bomb being placed on the doorstep of our children's future," said Indiana Rep. Mike Pence. "There is a rule back in Indiana where I grew up: When you are in a hole, stop digging."
But House Majority Leader Steny Hoyer of Maryland was quick to castigate Republicans for their own profligate spending when they were in charge. "When their side controlled the presidency, the House, the Senate, they jettisoned paying for things," he said. "And what happened? We went from substantial surpluses under the Clinton administration, to substantial deficits under the Bush administration."
A Political Quid Pro Quo?
Hoyer was able to get the bill passed while the Senate couldn't for a simple reason: He appended it to another bill requiring that most future legislation costing money would not be allowed to add to the deficit — that it would have to be offset by other spending cuts or tax increases. That helped win the votes of the so-called Blue Dog Democrats, the party's fiscal conservatives.
But Republicans weren't just angry about the fact that the bill was not paid for. They said the bill was a political quid pro quo.
"This is nothing more than a repayment to the American Medical Association for endorsing the larger health care bill that was on the floor several weeks ago," said Joe Barton of Texas.
Hoyer was quick to disagree.
"This is not a question of payoff to anybody," he said. "This was in the president's budget when he sent it down here earlier this year. It was in our budget that we passed, the House and the Senate. We said we were going to do it. Why? Because it's the right thing to do."
But there's no question that getting the AMA's endorsement for the health overhaul bill was a coup for Democrats. The AMA is known as a Republican-leaning organization, and its opposition has killed several previous health overhaul efforts.
And while the organization hasn't said it would withdraw its endorsement if the Medicare cuts aren't canceled, it has lobbied hard. "It's time; Congress cannot continue to put Band-Aids on the problem, and it's time for a permanent fix or permanent action from Congress to stabilize the security of Medicare for seniors," said Rebecca Patchin, chairwoman of the AMA board of trustees.
Time Running Out
And what of the Republicans who didn't pay for previous Medicare fixes but want to now? House Minority Whip Eric Cantor of Virginia was ready with an answer: "Listen, we were also fired by the voters in '06 and essentially fired in '08. I think we've learned our lesson."
What happens now, however, remains unclear. The Senate has already rejected the House's multiyear Medicare doctor fee fix. A test vote in October that required 60 votes didn't even muster a majority.
Meanwhile, the health overhaul bill now on the Senate floor would eliminate the 2010 Medicare pay cut. But even in a perfect world, there's virtually no chance it could be enacted before the cuts take effect Jan. 1.
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RENEE MONTAGNE, host:
Doctors who serve Medicare patients were looking at sharp reductions in payments come next year. But the House approved a measure, yesterday, that canceled those planned cuts. In the past, such bills were mostly routine and bipartisan. As NPR's Julie Rovner reports, that wasn't the case yesterday.
JULIE ROVNER: Just about everyone agrees that the current system under which Medicare pays doctors is broken. Unless Congress acts, doctors will see their Medicare payments drop by 21 percent beginning January 1st. California Democrat Henry Waxman says that can't be allowed to stand.
Representative HENRY WAXMAN (Democrat, California): Medicare's ability to guarantee healthcare for seniors would be eliminated if these cuts went into effect.
ROVNER: And Michigan Republican Dave Camp said he sent a letter to the American Medical Association signed by all his fellow Republicans on the Weighs and Means Committee.
Representative DAVE CAMP (Republican, Michigan): And in that letter we make a couple of points. And one is that we support fixing the physician payment formula in a long term way.
ROVNER: But at the same time, Camp adds�
Representative CAMP: Doctors should not ask us to sacrifice our children's future by adding more than $200 billion to the debt.
ROVNER: And whether to add those billions to the federal deficit was, at least on the surface, what yesterday's fight was about. Republicans claim they didn't want to vote for the bill, because the $210 billion cost wasn't paid for. House Majority Leader Steny Hoyer admitted as much, but pointed out Republicans did the same thing to cancel previous Medicare doctor pay cuts when they were in charge.
Representative STENY HOYER (Democrat, Maryland): As you added to the deficit every time you fixed it, one year at a time.
ROVNER: But underneath the surface there was another fight brewing. Texas Republican Joe Barton.
Representative JOE BARTON (Republican, Texas): This is nothing more than a repayment to the American Medical Association for endorsing the larger health care bill that was on the floor several weeks ago.
ROVNER: Majority Leader Hoyer was quick to deny any quid pro quo.
Representative HOYER: This is not a question of payoff to anybody. This was in the president's budget. It was in our budget. We said we were going to do this. Why? Because it's the right thing to do.
ROVNER: Still, getting the AMA's endorsement for their health overhaul bill was a coup for the Democrats. That's because the AMA is a traditionally Republican-leaning group, as well as one that's respected by the public. That's left Republicans still smarting.
But Democratic leaders in both the House and Senate fear that if the doctors don't get their pay cut restored, the AMA's endorsement of the health bill may not stand. AMA officials haven't said that, but they've been very firm in their determination to get the Medicare cut reversed. Rebecca Patchin is the organization's board chair.
Ms. REBECCA PATCHIN (Board of trustees, American Medical Association): It's time. Congress cannot continue to put Band-Aids on the problem and it's time for a permanent fix or permanent action from Congress to stabilize the security of Medicare for seniors.
ROVNER: Meanwhile, in an effort to stabilize relationships within their own party, House Democrats added to the doctor fee bill that's not paid for, language that would require that most future legislation will have to be offset by other spending cuts or increases in taxes.
And what of the Republicans who didn't pay for previous Medicare fixes but want to now? House Minority Whip, Eric Cantor, was ready with an answer.
Representative ERIC CANTOR (Republican, Virginia): Listen, we were also fired by the voters in '06 and essentially fired in '08. I think we've learned our lesson.
ROVNER: In the end, the bill passed on a nearly straight party line vote. But its prospects in the Senate are bleak. A similar bill failed an early test vote last month. The health overhaul bill now pending in that chamber would cancel the pay cut for a single year, 2010, but it's unlikely to be enacted before the cuts take effect in January.
Julie Rovner, NPR News, Washington.
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MONTAGNE: This is NPR News. Transcript provided by NPR, Copyright National Public Radio.
