- The Washington Times - Friday, November 20, 2009

The Democrat-controlled House voted Thursday to add more than $200 billion to the deficit to prevent steep Medicare payment cuts to doctors, a move Republicans denounced as a political payoff.

The measure, approved on a near party-line vote of 243-183, is a top priority for the American Medical Association (AMA). The Republican Party contended that Democrats supported the bill to thank the doctors group for backing President Obama’s health care overhaul.

“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 Rep. Joe L. Barton, Texas Republican.

“This is not a question of payoff to anybody,” retorted Majority Leader Steny H. Hoyer, Maryland Democrat. “It’s the right thing to do.”

Doctors are facing a 21 percent reduction in Medicare reimbursement rates in January unless Congress acts first, the result of a flawed funding formula that lawmakers have had to step in nearly annually to block in recent years.

The bill passed Thursday attempts a permanent fix by restructuring the payments to factor in how much doctors spend on various services, among other changes.

Past votes on the issue have been largely bipartisan, but this year the doctor payment issue has become a proxy for the larger health overhaul debate. Only one Republican voted “yes” Thursday, Rep. Michael C. Burgess of Texas, an obstetrician. Eleven Democrats voted “no.”

Despite intense lobbying by the AMA, the doctor payment legislation failed in the Senate last month in an embarrassing defeat, with moderate Democrats concerned about the deficit joining Republicans to bring it down. That leaves its future uncertain even though the rate cuts loom in less than two months.

The Obama administration has sought a permanent solution to avoid the uncertainty of one-year payment patches, and House Democrats obliged by including it in their 10-year health overhaul bill.

But before passing the overhaul bill earlier this month, they took out the doctor payment measure, in part to keep the cost of the overall bill low enough to meet Mr. Obama’s target price tag. Democratic Rep. Pete Stark of California acknowledged as much during Thursday’s debate.

“The reason it was separated, I would have to admit, was purely political,” Mr. Stark said. “We had to abide by the president’s request that we not exceed certain costs.”

Although House Democrats have vowed not to pass legislation that’s not paid for, the doctor payment bill is one of several items they’ve exempted from that rule, and the Congressional Budget Office says it would increase the deficit by $210 billion over 10 years. Republicans devoted much of Thursday’s debate to complaining about that, but Democrats said it was Republicans’ fault for setting up the problematic payment formula in the first place.

As a salve to Democratic fiscal hawks upset that the bill adds so much to the deficit, party leaders added a so-called pay-as-you-go provision aimed at making sure that future tax cuts or increases in benefit programs are “paid for” with spending cuts or tax increases elsewhere.

Unlike existing pay-go rules, which have been routinely waived, the pay-go measure would be set in law and be enforced with across-the-board spending cuts to several federal benefit programs, including Medicare and farm subsidies.

House Speaker Nancy Pelosi, California Democrat, insists that the new pay-go law be in effect as a condition of using deficit dollars to pass the Medicare payment fix and a variety of expiring tax cuts. The Senate hasn’t acted on another pay-go bill passed this summer.

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