Speaker John Boehner, the weakest man in D.C.? (Kevin Lamarque/Reuters)
How out of House Speaker John Boehner's control is his caucus? Enough to block a permanent solution to a problem that has vexed the health care industry, senior citizens and Congress for a decade and a half. The so-called
Medicare "doc fix" is a perennial headache for Medicare providers, patients and Congress. It's included in they payroll tax cut and unemployment benefits extension bill congressional negotiators are now trying to hammer out.
This time around, Democrats thought they had the permanent solution to the "doc fix" problem: eliminate the flawed policy permanently, and fund reimbursements with savings from the Iraq and Afghanistan draw-downs. That approach got the support of key Republicans, including Rep. Phil Gingrey, the co-chairman of the GOP Doctors Caucus. That caucus, and Gingrey, are usually deferred to by leadership when it comes to health care legislation.
Apparently not this time. Lobbyist sources tell TPM that "the GOP caucus is divided on the idea and making things tough for leadership," and that leadership will give in and block this solution.
On one side of the GOP divide are Kyl, Gingrey and other members who have close ties to the physician community and see OCO [war savings] as their best opportunity to fix the problem for good—they argue that both OCO and SGR [the "doc fix"] are gimmicks so they can cancel each other out. But that view is opposed by staunch conservatives who see OCO as a sleight of hand and fear that it could open the door to letting Dems use the fund for additional stimulus measures. Some GOP lawmakers also want to use the “doc fix” as leverage to cut health care reform and Medicare, which House Republicans passed in their December payroll tax package.
Top Republicans say they want at least a two-year “doc fix” if not a permanent solution, although the lobbyists TPM spoke with fear the current polarized climate could lead to yet another short term patch of between two and six months, despite their hopes to the contrary.
The House GOP seems pretty intent on making as many enemies as they can in their effort to avoid giving President Obama a win. They'll happily see the middle class tax break go away. They're fine with the fact that the American Hospital Association has essentially
declared war on them over obstruction on the "doc fix." They also don't particularly care that thousands, potentially tens of thousands, of seniors could lose access to care if health care providers stop taking Medicare patients because of the huge cut they face.
In other words, they're gleefully shooting themselves in the foot with the American electorate in order to deny President Obama a win. And apparently, John Boehner can't do a damned thing about it.