Maneuvering around last-second snags with some backroom intrigue, House GOP leaders used a voice vote Thursday to pass another temporary patch to prevent a massive cut to doctors' Medicare payments.
The decision by Republican leaders to circumvent the planned roll-call vote caught many of their own members by surprise.
"They voiced it? Oh, my God," exclaimed Budget Chairman Paul Ryan as he walked onto the House floor.
Democrats could have opposed the process and demanded a roll-call vote be taken, but House Minority Leader Nancy Pelosi had given assurances they wouldn't do that. At the very least, the use of a voice vote does not provide the public with a record of who actually supported the measure and who opposed it.
The bill is now expected to be taken up by the Senate.
Doctors face a 24 percent cut in their Medicare payments Monday if Congress doesn't act by then. Medicare's payment formula calls for ever-increasing cuts, which Congress always delays.
The voice vote occurred without fanfare after a series of closed-door meetings between House GOP leaders and some rank-and-file members — including members of the GOP doctors' caucus who opposed doing another stop-gap fix but were apprised of the voice-vote strategy before it happened.
Doctors groups, such as the American Medical Association, have been lobbying for a permanent change in Medicare's payment formula rather than the temporary patches Congress always passes.
Adding another hurdle was that Democrats on Thursday morning took to the House floor to denounce the temporary patch in the "doc fix," or more formally, the Sustainable Growth Rate, in favor of a permanent fix.
"It is unfortunate that we have been put in this position with less than 48 hours notice of what's in this bill, to do something that all of us knows needs to be done," House Minority Whip Steny Hoyer said.
On Wednesday, Speaker John Boehner had said the deal had been worked out with the Senate to get the measure done.
But with the problems internally within his own caucus, and the opposition of Democrats, the planned process for passing the bill was scrapped. That expedited process would have required two-thirds of the 432-seat House to vote for it, meaning more than 50 of the 199 Democrats would have had to go along, even if all Republicans had supported it.
Throughout the closed-door meetings, Majority Leader Eric Cantor kept saying he remained "confident" that House action would still occur on the measure and that "we are working on it." The ultimate solution was to hold a voice vote that many members did not realize occurred.
Rep. Peter Welch, D-Vt., expressed outrage at the process, saying, "I didn't know it happened. We should be voting."
Rep. Gerry Connolly D-Va., who vocally voted no, said there wasn't a request for recorded vote because "there were concerns raised on the Senate side not to do that," and there was no alternative.
But was this anything other than sneaky? "To quote the House of Cards, 'You might very well say that, but I cannot comment that,' " Connelly said. "I've been dying to say that."
The House passed a $137 billion permanent fix on March 14, which relied on savings tied to the repeal of the Affordable Care Act individual-insurance mandate. But that was rejected by the Democrats who lead the Senate, and it faced a presidential veto threat.
The temporary, smaller bill includes spending offsets from reductions in other Medicare spending; also, some of its costs are paid for by realigning sequester savings set to occur in 2025 to 2024.
Specifically, the Protecting Access to Medicare Act of 2014 would prevent the 24 percent cut in reimbursements to doctors who treat Medicare patients by replacing it on April 1 with adoption of a 0.5 percent update through Dec. 1. There would be no percentage changes for the three months following that through April 1, 2015.
Along with extending payments under SGR through March of 2015, the bill also includes funding for various other expiring Medicare provisions.