House Approves Temporary ‘Doc Fix’

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By Meghan McCarthy, with Peter Cohn and Billy House contributing

The House Thursday passed a temporary patch to raise doctors' pay 2.2 percent through November, nearly one month after they took a 21 percent cut in pay for Medicare services on June 1.

House members voted 417-1 to support the retroactive, six-month Senate-passed "doc fix," even after Speaker Pelosi last week called the legislation inadequate. The House passed a 19-month fix to the Medicare reimbursement formula in May -- whittled from a once-proposed five-year fix -- in a package that also included extensions for unemployment benefits.

But during her weekly news conference Thursday, Pelosi acknowledged the House had no option but to act on the Senate-passed legislation, as a larger package of legislation that includes $35.5 billion in unemployment insurance extensions and a $16 billion boost in federal Medicaid assistance to states languished on the Senate floor.

"What we had hoped to do was send it back to them with unemployment insurance and the rest, but it's clear that at this time they can't pass that," said Pelosi.

The broader tax bill failed yet again in the Senate, perhaps for the last time, on a 57-41 vote. Sen. Olympia Snowe, R-Maine, gave a lengthy floor speech in which she ticked off a laundry list of reasons for opposing the bill, mainly because of tax increases on small businesses organized as S corporations and multinational firms' overseas operations. Snowe's vote was needed, as Sen. Ben Nelson, D-Neb., continued his opposition to any portion of the bill being un-offset. The latest version would add $33 billion to the deficit over the next decade.

When asked about the fate of the failed extender bill, Majority Leader Reid repeatedly directed questions to the Republicans. "What else can we say?" he asked. Reid said the Senate would next turn to a package of small business incentives.

House Democrats were outspoken in their distaste for having to pass the Senate's shorter "doc fix" bill.

"This is a flawed bill that we're now considering, but we're forced to consider it because of the Republican filibuster in the Senate," said House Ways and Means Chairman Sander Levin.

House Energy and Commerce Chairman Henry Waxman echoed Levin's laments.

"After all is said and done, no one can say this is a great bill. It's an embarrassment, it's a disappointment," said Waxman, "but it has come to this."

The $6.5 billion "doc fix" bill passed the Senate by unanimous consent last week, and is fully offset with two revenue-raising provisions. One would ban hospitals from charging Medicare for outpatient and inpatient services rendered within 72 hours of a hospital admission, estimated to save $4.2 billion. The other would raise $2.8 billion by allowing companies to spread out their pension fund obligations over a longer period, which is expected to raise taxable income at firms.

Some House Democrats initially balked at the pensions pay-for when the legislation passed the Senate, but by Thursday evening members were faced with few options.

"I think the conclusion is that the Senate is disorganized and can't get its act together on a broader bill; they sent this to us, and we have to pass it in order to get the SGR for five months moving so we don't have doctors taking the cut," said Waxman, who added that Democrats would spend the next five months looking for a permanent fix.

Reaction to the passage of the "doc fix" legislation was tepid at best from doctors' and seniors' groups.

"The short-term Band-Aid passed tonight gives little reassurance to the 46 million Americans in Medicare who need reliable access to their doctors. The time for Congress to find a long-term physician payment solution is far past due," said AARP Executive Vice President Nancy LeaMond.

AMA President Cecil Wilson called the legislation a "very temporary reprieve," and warned Congress that the cuts to doctors' pay would only grow in 2011.

"In December, the Medicare physician payment cut will be a whopping 23 percent, increasing to nearly 30 percent in January. Congress is playing a dangerous game of Russian roulette with seniors' health care."

American Federation of State, County and Municipal Employees Legislative Director Charles Loveless blasted Senate Republicans for holding up the larger extenders legislation.

"The unwillingness of Senate Republicans to allow the jobs bill to move forward is placing states ever more closely to the edge of a financial precipice," said Loveless.

"Next week marks the beginning of the new fiscal year for most states, and unless the [Medicaid] funding is forthcoming, there will be devastating cuts in services and in public and private sector jobs."