The House Just Did Something Sneaky to Pass the ‘Doc Fix’

House GOP leaders on Thursday used a voice vote to pass a temporary health care fix, surprising members.

Speaker of the House John Boehner.
National Journal
Billy House Elahe Izadi
March 27, 2014, 8:49 a.m.

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.

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