Despite a brief burst of bipartisanship, both sides have retrenched in their search for a solution to exploding payments to doctors who treat Medicare patients, with the House GOP planning to put a partisan bill on its chamber floor Friday.
Late last year, Republicans and Democrats announced they'd reached agreement on a way to rewrite the payment formula, which for more than a decade has called for deep cuts — sending lawmakers scrambling every year or so to pass a patch.
But the new agreement comes with a price tag in excess of $100 billion, and like everything else in Washington in the last few years, the two parties have stalemated over how to pay for it.
The GOP's new bill, which the House will vote on Friday, would scrap Obamacare's individual mandate and use savings from that to cover the costs of repealing the old Medicare payments formula, known in Washington-speak as the Sustainable Growth Rate or "doc fix."
President Obama has vowed a veto and Democrats said to even bring the bill to the floor breaks faith with last year's agreement.
"With their 51st vote to repeal and undermine the Affordable Care Act, they are turning their toxic, empty partisanship against health and security of our nation's seniors," said House Minority Leader Nancy Pelosi, California Republican.
Groups like the AARP and American Medical Association also have opposed the GOP's approach.
"This policy will only become law if Congress collaborates in a bipartisan manner to resolve the fiscal matters associated with this legislation," AMA CEO James L. Madara wrote Thursday in a letter to Mrs. Pelosi and House Speaker John A. Boehner, Ohio Republican.
The current patch expires at the end of this month, putting pressure on Congress to finish off what had been a fruitful endeavor so far.
The individual mandate is a key part of Mr. Obama's health overhaul because it forces young, healthy people to get coverage they will rarely use in order to offset insurers' costs when they cover older consumers with pre-existing medical conditions.
Mr. Obama this week threatened to veto the bill because it undermines his health care law, placing pressure on Democrats to choose between their party leader in the White House and a deal that scraps both an unpopular mandate and a clunky Medicare formula.
Republicans say it makes sense to tie Obamacare to the doc fix, arguing that if the individual mandate is eliminated, fewer people would be compelled to use the Obamacare marketplace and qualify for government subsidies. The savings from those subsidies could go to bolster the doctor payments in Medicare.
Rep. Michael Burgess, Texas Republican, said plenty of Democrats have bucked the Obama administration before and supported House measures to exempt certain persons from the health care law's individual mandate, which exposes people to fines if they fail to get health coverage.
"It looks like there is growing support for delaying the individual mandate," he said. "I think using that as a pay-for is reasonable."
Mr. Obama already imposed one delay in the individual mandate by allowing people to sign up for Obamacare plans until March 31, instead of an initial deadline of Feb. 15. His administration has also said people with bare-bones plans may be able to keep their coverage through 2016 and still avoid penalties they'd otherwise pay for having noncompliant coverage.
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