House Leaders Want to ‘Jam the Senate’ With Bipartisan ‘Doc Fix’ Deal

That’s the plan, but House conservatives worry that they’re the ones getting a raw deal.

US Representative John Boehner, Republican of Ohio, holds up his gavel after being re-elected as Speaker of the House alongside US Representative Nancy Pelosi, Democrat of California and returning Minority Leader, during the opening session of the 113th US House of Representatives at the US Capitol in Washington, DC, on January 3, 2013.  
National Journal
Sam Baker and Dylan Scott
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Sam Baker Dylan Scott
March 17, 2015, 1:03 p.m.

House Re­pub­lic­an lead­ers are work­ing to sell fisc­al hawks who might be un­happy with the Medi­care “doc fix” deal with Nancy Pelosi that at least they’d be put­ting the pres­sure on the Sen­ate if they pass it.

In a closed-door meet­ing Tues­day, House Ways and Means Chair­man Paul Ry­an and En­ergy and Com­merce Chair­man Fred Up­ton briefed mem­bers on the work be­gun by the of­fices of House Speak­er John Boehner and Minor­ity Lead­er Pelosi.

Ry­an and Boehner tried to con­vince their col­leagues that they would “jam the Sen­ate” by passing a doc-fix deal with Pelosi’s help, said Rep. Tim Huel­skamp of Kan­sas.

But Huel­skamp said he thought the in­ten­tion had been to put House con­ser­vat­ives in a tough spot, cit­ing Boehner’s ini­tial ne­go­ti­ations with Pelosi as evid­ence. The cur­rent doc-fix patch ex­pires April 1, leav­ing little time for Con­gress to de­bate and pass any long-term deal.

“He didn’t come to us and say, ‘How do we fix the doc fix, work­ing with Mitch Mc­Con­nell?’ He went to Nancy Pelosi,” Huel­skamp said. “This is the first time we’ve heard about the doc fix. We’re in the middle of March. He was sit­ting down with Nancy first and then he’s come back to con­fer­ence and said, ‘Hey, we’ve got the votes. I’m go­ing to ram it through. To­geth­er, we’re go­ing to jam the Sen­ate.’

“No,” Huel­skamp con­cluded. “It’s to jam House Re­pub­lic­an con­ser­vat­ives.”

But across the Cap­it­ol, some Sen­ate Re­pub­lic­ans soun­ded like they might be just fine with get­ting “jammed.”

Sen­at­ors from both parties said Tues­day that they’re con­tent to let the House con­tin­ue to take the lead on the per­man­ent doc fix, and im­plied that if a bill could pass the House, it would stand a pretty good chance in the Sen­ate.

“If this [sus­tain­able growth rate] fix passes the House, I think there are a num­ber of us that will en­cour­age the lead­er to bring it to the floor,” said GOP Sen. John Bar­rasso of Wyom­ing.

Rep. Joe Pitts of Pennsylvania, chair­man of the House En­ergy and Com­merce Sub­com­mit­tee on Health, said he’s got­ten the same in­dic­a­tion from the Sen­ate.

“What I hear from my friends on the oth­er side of the Cap­it­ol is they’re will­ing to go along with this,” Pitts said.

The re­por­ted deal, which Huel­skamp re­peatedly said he hadn’t seen yet, would ditch the “sus­tain­able growth rate” for Medi­care pay­ments to doc­tors and reau­thor­ize the Chil­dren’s Health In­sur­ance Pro­gram for two years. Its ex­pec­ted costs would be $200 bil­lion, about $70 bil­lion of which would be dir­ectly paid for through be­ne­fi­ciary and pro­vider cuts.

That’s the ex­pec­ted stick­ing point for fisc­al hawks, and Huel­skamp said he thought Boehner might have to vi­ol­ate the Hastert rule—the in­form­al rule that House lead­er­ship will put a bill on the floor only if a ma­jor­ity of the House ma­jor­ity will vote for it—to get it passed.

Rep. Steve King of Iowa, an­oth­er mem­ber on the House’s con­ser­vat­ive flank, also soun­ded skep­tic­al. He ref­er­enced the re­cent fight over De­part­ment of Home­land Se­cur­ity fund­ing, in which most Re­pub­lic­ans voted against the fund­ing bill (157 nays) but 182 Demo­crats voted for it to get it passed.

“They may well have put to­geth­er a pack­age that’s not de­signed to get more than 50 Re­pub­lic­an votes,” King said. “That will be a very dra­mat­ic thing if that’s what comes to pass.”

Sen­at­ors said they’re with­hold­ing their fi­nal judg­ments un­til they see the bill, but made clear that the Sen­ate will be tak­ing its cues from whatever the House lead­er­ship can put to­geth­er.

“I’m ready for a per­man­ent fix. I’ve got to see the de­tails,” said GOP Sen. Lamar Al­ex­an­der of Ten­ness­ee, the chair­man of the Sen­ate health com­mit­tee.

Not­ably, Bar­rasso—who is a doc­tor as well as a re­li­able con­ser­vat­ive—seemed to be on board with Boehner’s ap­proach to pay­ing for the meas­ure. Asked wheth­er he was con­cerned that the costs of the pack­age aren’t off­set with­in the tra­di­tion­al 10-year win­dow, Bar­rasso poin­ted to its longer-term cuts in be­ne­fits and pro­vider pay­ments—the same an­swer Boehner’s al­lies are giv­ing to con­ser­vat­ives.

“I want to see what the House ac­tu­ally can pass. “¦ I’m in fa­vor of com­pletely elim­in­at­ing the SGR and find­ing the best way to do it,” Bar­rasso said.

The deal could run in­to trouble with Demo­crats, both for its be­ne­fit cuts and a two-year CHIP ex­ten­sion. Sen. Ron Wyden of Ore­gon, the top Demo­crat on the Fin­ance Com­mit­tee, told re­port­ers that a four-year CHIP ex­ten­sion re­mains a pri­or­ity—but wouldn’t say wheth­er it would be a deal-break­er.

“We’ve got to move on to a mod­ern re­im­burse­ment sys­tem that will en­sure the well-be­ing of Medi­care for years to come, but we’ve got to do CHIP now,” Wyden said. “I think the real ques­tion is bal­ance. We’ve got to have a bal­anced pack­age.”

A bill will pass the House only with strong Demo­crat­ic sup­port, so a longer CHIP reau­thor­iz­a­tion wouldn’t ne­ces­sar­ily upend the polit­ic­al co­ali­tion around it. But if the House acts next week, sen­at­ors would have only a few days for de­bate and amend­ments—less if they need to send the bill back to the House.

“We’ll have enough time. We can read quickly,” Wyden said. “Let’s see what they put in writ­ing, be­cause they may do that quickly. Let’s see what, if any­thing, is passed in the House. We’re just stay­ing open to wait and see ac­tu­al de­tails.”

That means all eyes for the mo­ment are on the lower cham­ber. But there, pess­im­ism wasn’t uni­ver­sal among House con­ser­vat­ives. Rep. Jim Jordan of Ohio, an­oth­er card-car­ry­ing con­ser­vat­ive, told Na­tion­al Journ­al in an in­ter­view that he was open to the deal that’s be­ing dis­cussed. In par­tic­u­lar, he soun­ded re­cept­ive to, if not totally con­vinced by, the idea—be­ing for­war­ded by the de­fi­cit hawks at Amer­ic­ans for Tax Re­form in fa­vor of the bill—that the doc-fix bill’s re­forms would lead to longer-term sav­ings that the meas­ure might not be cred­ited with in a Con­gres­sion­al Budget Of­fice score.

“There’s good and bad. I want to see the four corners of the bill,” Jordan said. “Nev­er­the­less, the fact is it looks like it’s not all be­ing off­set for the full length of the bill, and that’s a prob­lem.”

Oth­er mem­bers of the House Free­dom Caucus were lin­ing up in sup­port of the plan. Rep. Matt Sal­mon said he had heard from some con­ser­vat­ives that the deal was no good be­cause it raised the de­fi­cit in the short term.

“But what are we do­ing every year when we do an end-of-year SGR fix?” Sal­mon said. “A per­man­ent fix is bet­ter than this tem­por­ary solu­tion.”

Daniel Newhauser contributed to this article.
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