The House on Thursday passed legislation to give doctors a reprieve from a looming 24 percent cut in their payments from Medicare.
The bill passed on a surprise voice vote and advanced to the Senate, which hopes to pass it before a Monday deadline. The vote came after an hourlong delay amid doubt that the measure could muster the two-thirds vote required under fast-track procedures.
The voice vote was engineered by Majority Leader Eric Cantor, R-Va., with cooperation from senior Democrats such as Minority Leader Nancy Pelosi of California.
Several leading Democrats opposed the bill, saying it would set back efforts to find a permanent fix for a flawed Medicare payment formula that has bedeviled lawmakers for more than a decade. There is widespread support for legislation to permanently solve the problem but no agreement on how to pay for it.
The measure represents the 17th time Congress has stepped in with a temporary fix to a poorly designed Medicare fee formula that dates to a 1997 budget law. The House vote came after efforts to permanently fix the formula appeared to have fizzled. Democrats such as Reps. Frank Pallone of New Jersey and Jim McDermott of Washington said they would oppose the measure because it would hurt the effort to find a permanent solution to the problem. Pelosi, however, weighed in to support the legislation.
The heavily lobbied legislation also contains numerous other health care provisions of interest to doctors, hospitals, drug companies and other health care providers.
Timing in the Senate was uncertain, although there was a lot of pressure to act by a Monday midnight deadline. Otherwise, Medicare would stop processing payments to doctors until the payment fix was enacted.
Senate Majority Leader Harry Reid, D-Nev., was likely to seek to speed the measure through the Senate as early as Thursday, but it would take cooperation from all 100 senators to make that happen.
There is widespread support for bipartisan legislation to repair, once and for all, the broken Medicare formula, but there is no agreement on how to bear the 10-year, $140 billion cost.
"The permanent fix that's being talked about is a good fix, and there's an agreement -- bipartisan, bicameral agreement on the long-term fix," House Speaker John Boehner, R-Ohio, said. "What there isn't agreement on is, `How are we going to pay for it?"' He said the House would vote Thursday on the temporary fix.
The powerful American Medical Association and a host of other health care provider groups weighed in against the measure, saying it would undermine the drive for a permanent solution.
"The endless cycle of short-term remedies that serve to support a failed policy are no longer acceptable," said the AMA and other groups in a letter to lawmakers.
"A vote `no' today is a vote against seniors," said Rep. Joe Pitts, R-Pa. "We are not voting for the AMA today."
New Senate Finance Committee Chairman Ron Wyden, D-Ore., wants to keep working on a permanent solution. He proposes using savings from lower costs for operations in Afghanistan. Republicans are demanding savings from President Barack Obama's health care law. The resulting impasse has left lawmakers little alternative other than to pass another temporary fix.
"If you just keep going with these temporary solutions, you waste time, you waste money, you threaten the access for seniors to their doctors," Wyden said. "And the reality is, the patches, as they are called, they're not free either. You still have to come up with the money."
The measure blends $15 billion to address Medicare physicians' payments with about $5 billion more for a variety of other expiring health care provisions, like higher Medicare payments to rural hospitals and for ambulance rides in rural areas. On Wednesday night, the Congressional Budget Office released an analysis that said the bill would increase spending by $14 billion over the next two years and that almost $11 billion of the legislation's savings wouldn't accrue until 2024.
The bill also contains a provision benefiting, among others, Amgen Inc., which produces an oral drug for kidney dialysis patients. It would extend through 2024 a controversial provision to allow payments for Sensipar, which is made by Amgen, to be made on top of other payments to treat Medicare patients with kidney disease. It also eases cuts to dialysis providers who have battled with drug companies over the issue.
The measure also would delay implementation of newer, more precise Medicare treatment and payment codes, which has upset the health care information management industry and specialty physicians who stand to benefit from the updated codes. But doctors are happy since it would save them from having to pay a lot of money to upgrade their payment systems.
The temporary measure is financed by a variety of cuts familiar to health care providers, though some gamesmanship is being employed. For instance, the measure includes additional cuts to hospitals that treat a "disproportionate share" of uninsured and Medicaid patients -- but delays planned implementation of existing cuts for a year. The authors of the bill also use budget gimmicks to squeeze more savings from a Medicare providers payment cut that is 10 years down the road.
The measure would give Medicare doctors a 0.5 percent fee increase through the end of the year. It also would create two new mental health grant programs, including $60 million over four years for outpatient treatment for people with serious mental illness. It adjusts the fee schedule under Medicare for providers who treat patients in California, a step designed to adjust for population growth.