WASHINGTON — President Barack Obama is poised to sign into law the most far-reaching health care reform bill since Obamacare, permanently ending the “doc fix” dilemma that has haunted Congress for more than a decade.
It also slashes Medicare benefits for upper-income seniors.
And in the strangest of twists, the legislation passed with overwhelmingly bipartisan support, an exceedingly rare achievement for a Congress that has all but ceased to address big, long-term problems.
The legislation passed the Senate on Tuesday night by a vote of 92-8. It was approved 392-37 by the House last month before Easter recess. Obama had endorsed the proposal as Speaker John Boehner (R-OH) and House Minority Leader Nancy Pelosi (D-CA) were closing in on a deal.
“It’s another reminder of a new Republican Congress that’s back to work,” said Senate Majority Leader Mitch McConnell (R-KY)
On the urging of Boehner and McConnell, the Senate rejected six amendments to the legislation offered by both parties and approved it as written. Boehner is expected to send Obama the legislation after a House signing ceremony on Thursday.
“Through this bold, necessary legislation, we have secured critical support for low-income seniors, for poor children, and for underserved communities across the country,” said Pelosi.
The legislation has three broad components.
First, it fixes a gaping hole in the Medicare program by replacing the formula to pay physicians — known as the Sustainable Growth Rate — which imposes steep annual cuts that Congress has routinely overridden for 12 years. Instead doctors will receive a 0.5 percent pay bump for each of the next five years before transitioning to a new system aimed at paying them for quality of care.
From left, House Minority Leader Nancy Pelosi of Calif., Senate Majority Leader Mitch McConnell of Ky., Senate Minority Leader Harry Reid of Nev. and House Speaker John Boehner of Ohio hold hands. (AP Photo/Susan Walsh)
Second, it cuts billions of dollars from Medicare. It requires seniors who earn between $133,500 and $214,000 a year (and couples making twice that amount) to pay more for insurance and prescription drug coverage, and cuts spending on supplemental Medigap plans in order to discourage over-utilization of services on the taxpayer dime. It also modestly reduces long-term spending on providers of hospice care, home health services and nursing homes.
Third, it extends the Children’s Health Care Program for two years, moving the new expiration date to October 1, 2017. (Democrats had pushed for a four-year extension but House Republicans rejected that idea and Senate Republicans killed an amendment to that effect.)
Physician groups, including the American Medical Association, rejoiced.
The long-term Medicare changes are an important legacy achievement for Boehner, whose restive right flank has for years thwarted his efforts to secure entitlement deals with Democrats. This time many House conservatives, fed up with perennial “doc fixes,” gave him their blessing to cut the deal with House Minority Leader Nancy Pelosi (D-CA) and stood by him.
In the end, most of the opponents were hardline Republican fiscal hawks who complained that the permanent “doc fix” wasn’t fully paid for, including Sens. Ted Cruz (TX) and Marco Rubio (FL). It is projected by the nonpartisan Congressional Budget Office to add $141 billion to the deficit in the next decade.
Notably, numerous GOP fiscal hawks who have a background as physicians put aside their deficit concerns to vote for the measure, including Sen. Rand Paul (KY), Sen. John Barrasso (WY), Rep. Tom Price (GA), Rep. John Fleming (LA) and Michael Burgess (TX). The Medicare benefit cuts were a draw for some conservatives.
“Thanks for all your hard work, Mitch,” Senate Finance Chair Orrin Hatch (R-UT) whispered to McConnell on the floor seconds after the bill passed.
Obama called the legislation a “milestone” for doctors and seniors on Medicare.
“This bipartisan bill will protect health coverage for millions of Americans, and I will be proud to sign it into law,” he said in a statement. “I hope Congress builds on this good work by finding more ways to make sure every American has access to the quality, affordable health care they deserve.”