The House on Thursday overwhelmingly voted to repeal automatic payment cuts to doctors under Medicare, endorsing a rare bipartisan deal that Speaker John Boehner (R-Ohio) negotiated with Democrats.
The bill, which passed by a vote of 392-37, puts Congress on the precipice of ending a fight nearly two decades old over a formula known as the sustainable growth rate (SGR).
Since 2003, lawmakers have put off cuts under the Medicare formula 17 times, perennially punting the solution through short-term “fixes” that, over time, ran up the cost of abolishing the formula to nearly $200 billion dollars.
{mosads}Facing a new deadline for the cuts at the end of March, Boehner said he decided it was time to make a deal.
“We’ve had a patch of this problem 17 times,” Boehner said in a speech on the House floor. “And I decided about a year ago that I had had enough.”
Boehner and House Minority Leader Nancy Pelosi (D-Calif.) have been in negotiations over the measure since January and worked quietly to bring their members behind it.
Only 33 Republicans and 4 Democrats voted against the bill.
Pelosi praised the deal, saying it had been a “privilege” to work with Boehner “in a bipartisan way on this legislation.
“I hope it will be a model of things to come,” she said.
Boehner likewise touted the bipartisanship and argued passage of the bill was a step toward broader entitlement reform.
“This is what we can accomplish when we focus on finding common ground,” he said.
But while the mood in the House was celebratory, the fate of the legislation in the Senate remains unclear.
Senate Democrats have given the bill a frosty reception, raising concerns about abortion language and the length of an extension for a children’s insurance program.
But some Democratic senators appeared to be warming up to the deal on Wednesday, and President Obama gave it a strong endorsement, saying he has his “pen ready” to sign it.
Boehner told reporters ahead of the vote that he expects the Senate to take up the bill “sooner rather than later,” and said he believes it will ultimately pass both chambers.
“I expect, when the Senate does it take it up, there’ll be a large vote over there as well,” he said.
The Senate is in the middle of a “vote-a-rama” on budget amendments that is expected to stretch into the early hours of the morning. Once the budget is passed, Senate Majority Leader Mitch McConnell (R-Ky.) could seek unanimous consent to approve the Medicare deal before the chamber leaves town for a two-week recess.
But if any senator objects to unanimous consent on the bill, it could force Congress to again pass a short-term “doc fix” to buy time for a Senate debate in April.
Boehner has ruled out passing a short-term patch, however, and the administration also has ways to delay payment cuts to doctors on its own for two weeks.
The deal crafted by Boehner and Pelosi would cost $214 billion over 10 years, with $73 billion of that cost offset with spending cuts or new revenue, according to the Congressional Budget Office (CBO). The bill includes reforms to transition Medicare’s payment system from incentivizing quantity to quality in care and is likely to produce small savings for the government over time, according to the CBO.
Boehner has said the bill would cost less than if Congress continued on its current course of approving short-term patches.
Senate Democrats have expressed concerns that the bill includes language from the Hyde Amendment, which bans federal funding for abortions, for community health center funding.
Pelosi was able to secure additional language making clear that the language expires when the funding does, and argues there is no change from the status quo, because the Hyde Amendment already applies to health center funding.
Both Reps. Jim McGovern (D-Mass.) and Pete Aguilar (D-Calif.) objected to the abortion language Thursday, despite supporting the bill.
“This is clearly another attack to block access to reproductive care,” Aguilar said on the floor.
Senate Democrats have also pressed for four years of funding for the Children’s Health Insurance Program, instead of the two years in this bill. Senate Minority Leader Harry Reid (D-Nev.) has declined to give the measure his backing so far, saying he was waiting for the House vote.
Some of the offsets in the bill have drawn opposition from Democrats. The measure would make seniors earning more than $133,000 pay a higher share of premium costs, and would create a $147 deductible for certain supplemental “Medigap” plans.
There are also cuts from hospitals and skilled nursing centers, but industry groups have supported the deal, arguing the trade-offs are worth it to eliminate the SGR.
Lawmakers said they hoped the bipartisan deal could be a model for Congress.
”I hope this bipartisan approach is contagious,” McGovern said.
Added Rep. Renee Ellmers (R-N.C.): “Don’t look now, but we are actually governing.”
— Updated at 1:20 p.m.