The House did Thursday what the Senate couldn't do a month ago: It passed a bill to cancel a 21 percent pay cut for doctors who treat Medicare patients that's set to take effect Jan. 1 without legislative intervention.
Passage of the bill was by a near party-line vote of 243-184, and came over the vehement objections of Republicans, who complained bitterly that the measure's $210 billion, 10-year cost was not offset by other spending cuts or tax increases.
"The truth is spending policies of this Congress and this administration are a fiscal time bomb being placed on the doorstep of our children's future," said Indiana Rep. Mike Pence. "There is a rule back in Indiana where I grew up: When you are in a hole, stop digging."
But House Majority Leader Steny Hoyer of Maryland was quick to castigate Republicans for their own profligate spending when they were in charge. "When their side controlled the presidency, the House, the Senate, they jettisoned paying for things," he said. "And what happened? We went from substantial surpluses under the Clinton administration, to substantial deficits under the Bush administration."
A Political Quid Pro Quo?
Hoyer was able to get the bill passed while the Senate couldn't for a simple reason: He appended it to another bill requiring that most future legislation costing money would not be allowed to add to the deficit — that it would have to be offset by other spending cuts or tax increases. That helped win the votes of the so-called Blue Dog Democrats, the party's fiscal conservatives.
But Republicans weren't just angry about the fact that the bill was not paid for. They said the bill was a political quid pro quo.
"This is nothing more than a repayment to the American Medical Association for endorsing the larger health care bill that was on the floor several weeks ago," said Joe Barton of Texas.
Hoyer was quick to disagree.
"This is not a question of payoff to anybody," he said. "This was in the president's budget when he sent it down here earlier this year. It was in our budget that we passed, the House and the Senate. We said we were going to do it. Why? Because it's the right thing to do."
But there's no question that getting the AMA's endorsement for the health overhaul bill was a coup for Democrats. The AMA is known as a Republican-leaning organization, and its opposition has killed several previous health overhaul efforts.
And while the organization hasn't said it would withdraw its endorsement if the Medicare cuts aren't canceled, it has lobbied hard. "It's time; Congress cannot continue to put Band-Aids on the problem, and it's time for a permanent fix or permanent action from Congress to stabilize the security of Medicare for seniors," said Rebecca Patchin, chairwoman of the AMA board of trustees.
Time Running Out
And what of the Republicans who didn't pay for previous Medicare fixes but want to now? House Minority Whip Eric Cantor of Virginia was ready with an answer: "Listen, we were also fired by the voters in '06 and essentially fired in '08. I think we've learned our lesson."
What happens now, however, remains unclear. The Senate has already rejected the House's multiyear Medicare doctor fee fix. A test vote in October that required 60 votes didn't even muster a majority.
Meanwhile, the health overhaul bill now on the Senate floor would eliminate the 2010 Medicare pay cut. But even in a perfect world, there's virtually no chance it could be enacted before the cuts take effect Jan. 1.
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