By Paul Kane and Jason Millman
Thursday, March 26, 2015
Rarest of victories in House: Bipartisan health bill approved
By Paul Kane and Jason Millman
The House gave sweeping approval Thursday to a bipartisan plan to alter payment systems for Medicare providers and extend a popular children’s health program, fueling momentum for legislation that could soon reach President Obama’s desk.
The vote, 392 to 37, came as Senate Democrats’ resistance to the more than $200 billion health package faded and Obama signaled he would sign the plan.
After a first quarter of 2015 marked by gridlock, the legislation provides a modest but important victory that demonstrated congressional leaders have an ability to craft bipartisan deals when they believe it is in their interest.
The proposal, negotiated by House Speaker John A. Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.), has been embraced by liberals seeking increased funds for programs that are key to advancing Obama’sAffordable Care Act and by conservatives cheering an increased premium charged to wealthy recipients of Medicare.
It sets up one of the most rare moments in Obama’s second term, a piece of legislation that meets the approval of the president, the speaker and their respective allies.
“As we speak, Congress is working to fix the Medicare physician payment system,” Obama said Wednesday, at a White House ceremony commemorating the fifth year of ACA’s enactment. “I’ve got my pen ready to sign a good, bipartisan bill, which would be really exciting.”
Moments before the vote, Boehner took a much-needed victory lap after a bruising January and February that had some questioning his ability to lead the House. “This will be the first real entitlement reform that we’ve seen in nearly two decades, and that’s a big win for the American people. It was a true bipartisan agreement, and I want to thank leader Pelosi,” the speaker told reporters Thursday.
The linchpin of the assembled package of health bills is a permanent fix to the Medicare pricing system for physicians. Congress and the health-care industry have long sought an overhaul. The system originates from a 1997 law that tied physician payments to the growth of the economy, but doctors soon faced double-digit reimbursement cuts as health-care costs grew faster than the economy.
Since 2003, Congress has on 17 occasions scrambled to pass legislation to avoid the scheduled cuts in Medicare payments, finding a combined $170 billion in budget savings during that time to offset the cost of making doctors’ payments whole again. Without action by March 31, the latest round of cuts was scheduled to kick in.
Despite the shared desire of Congress and doctors to overhaul this payment system, the price tag over the years was always considered prohibitive. The cost of repeal has come down recently, however, as health-care spending growth has slowed to historic levels over the past few years.
The House legislation follows through on a broad agreement that Medicare should better reward health-care providers for higher-quality care, instead of just paying them for each service they provide. It is a shift taking place in private insurance, and earlier this year, the Obama administration for the first time set a goal to tie the vast majority of Medicare payments to programs encouraging better care at lower costs.
The House bill does away with the scheduled payment cut and gives doctors an annual 0.5 percent raise in Medicare payments through 2019. After that, a new payment system based on the quality of care will take hold.
The most rebellious conservatives, who have often caused headaches for Boehner, split over the legislation. Some are furious that only about a third of the cost of the legislation is offset by cuts or increased revenue in other areas, complaining that this is a budget-busting bill that blows up the deficit.
However, a significant bloc of conservatives supported the legislation. Rep. Matt Salmon (R-Ariz.), who in January would not even support Boehner for speaker, called the current Medicare payment plan “intellectually dishonest” because Congress intervened every year to prevent the cuts. “Ending this charade is very important,” said Salmon, who also said that conservatives were getting a clear victory with another change to Medicare. “Finally, we’re going to do something.”
That is the provision that will require higher-income seniors to pay more toward Medicare premiums for their insurance and prescription drug coverage. Many Republicans believe that, while the initial estimates of savings hover around $30 billion over 10 years, the Treasury will recoup an exponentially larger sum over the next few decades and help the long-term finances of Medicare.
On the GOP side of the aisle, 212 Republicans supported the plan and just 33 opposed it, a big enough margin that Boehner’s caucus was just three votes shy of being able to pass the legislation on its own. Just four Democrats opposed the plan.
Democrats have previously resisted what is known as “means testing,” fearing that even a slight increase in premium costs to the most wealthy could lead to future encroachments onto other Medicare beneficiaries.
But there are plenty of other things that Democrats will like in the legislation, which was drafted by the bipartisan leaders of the House Ways and Means Committee and the House Energy and Commerce Committee.
The bill makes permanent a program that helps low-income Medicare beneficiaries afford their monthly premiums. It also extends by two years enhanced funding to community health centers, which primarily serve low-income patients.
The bill also extends funding for the Children’s Health Insurance Program for two years. The program, which is widely credited with helping to cut the rate of uninsured children by half since 1997, is scheduled to run out of federal funding in September. Senate Democrats on the powerful Finance Committee have been pushing for a four-year CHIP extension, but health-care advocates aligned with the Obama administration have said that they are happy to get at least the two-year addition.
Liberals also hailed the level of funding for CHIP and community centers, because it is set at levels that match those required by Obama’s health law — a rare moment in which Republicans are acceding to part of the ACA. Some abortion rights groups expressed concern about language in the legislation that forbids federal funds to be used to provide abortion services, but the House’s Pro-Choice Caucus issued a letter saying that there was nothing different in the bill than already existing prohibitions on federal funding.
As objections faded throughout the week, Obama’s declaration sealed the pact and made its passage all but certain. The last remaining question is whether the Senate can clear the legislation before adjourning for spring recess or whether it will take up the legislation upon its return April 13.
Just before the vote, Pelosi predicted that a massive vote of support in the House would probably help clear any hurdles in the Senate.
“I hope we have a big, strong vote here today and that will encourage the Senate to take up the bill as soon as possible so our work will be done before the deadline,” Pelosi said.
Mike DeBonis and David Nakamura contributed to this report.