Kumbaya?
The House is expected to vote Thursday on the plan House leaders John Boehner and Nancy Pelosi crafted to permanently repeal the Sustainable Growth Rate formula for Medicare payments to physicians, a formula that has been broken since it was passed nearly two decades ago. Because it's never worked, every year Congress has had to pass a temporary "doc fix" to avoid dramatic cuts in Medicare physician reimbursements. The existence of a bipartisan permanent fix, coming out of the insane Republican House is remarkable. Also remarkable is the
expectation that it will pass.
A floor vote is planned for Thursday, House leadership aides said, after the top Democrat and Republican successfully resolved concerns about abortion language.
"It is all shaping up very well on both sides," said Kevin Smith, a spokesman for Boehner.
Ah, but that "abortion language" is the kicker, and it's the reason that it is much less certain that the plan will pass the Senate. The nature of the "doc fix," a must-pass bill because it has two powerful constituencies—seniors and the medical community, means that it will be a magnet for other things. They can't resist tacking on a bunch of sweeteners, and those sweeteners end up being poison. That's the case here, when
$7.2 billion for community health centers was added. That's great. Community health centers
need to be funded. The problem is that Republicans insisted on anti-abortion Hyde amendment language being added to that funding, despite the fact that community health centers generally don't provide abortion and an executive action signed by President Obama when Obamacare passed makes doubly sure no federal funds will be used for abortion in these clinics.
House Democrats argue that it's okay to include the language because of those facts—it makes no difference. But the same argument could be turned against them—the anti-abortion language need not be included at all and is absolutely unnecessary. In fact, adding it—as Senate Democrats say—brings us that much closer to codifying the abortion ban in the law, as opposed to tacking it on as an amendment on spending bills. Accepting it means losing even more ground on choice, which so far Senate Democrats aren't willing to do. Additionally, the House agreement will include two years of funding for the Children's Health Insurance Program, which expires in September. Senate Democrats want four years of funding for CHIP.
Possibly the biggest hurdle facing the legislation is simply time. The Medicare fix has to pass by the end of this week or the cuts will hit, and both chambers of Congress will be leaving for the first two weeks of April for spring recess. If the House passes the bill Thursday, the Senate will only have a day to act, and the Senate is tied up this week with passing a budget. The likeliest outcome, at least in the near term, is a short-term fix that will prevent the cuts from kicking in on April 1.