Ever since I first heard that the House of Representatives was passing a bill that would eliminate the need for the doc-fix, I’ve been wondering two things. First, how in the world did this House find a bipartisan compromise solution to a truly vexing problem? Second, was the answer that the bill is a horrible capitulation on the Democrats’ part?
I’m generally pleased with the answers I found to both questions. Peter Sullivan’s column in The Hill provided a partial answer to how a compromise was reached. The key was really that the Democrats agreed not to insist on tax hikes in return for the Republicans not insisting on fully offsetting the cost of the reforms. I count that as a win for the Democrats, actually, as it means that they’ve broken the Tea Party insanity about deficit spending. Another key was that it was negotiated so secretly and quickly that it caught all the stakeholders by surprise that it was being negotiated at all.
Early this year, committee leaders asked House leadership for parameters they could look at on how to pay for SGR repeal. Boehner and Pelosi’s healthcare staffs began meeting in early February, laying the groundwork for the two leaders’ meeting in March.
The Boehner-Pelosi talk ushered in the final stretch of negotiations, with members of the Energy and Commerce and Ways and Means committees brought back into the picture. Pelosi met with the ranking members of those panels, Reps. Frank Pallone (D-N.J.) and Sander Levin (D-Mich.), the same day she met with Boehner.
Up until that point, the talks had been kept secret. Healthcare lobbyists and groups who have fought for years to end the SGR were completely in the dark.
For a while, it looked like abortion language might hold up an agreement, and Senate Finance ranking member Ron Wyden (D-OR) applied the brakes. But Pelosi was able to work out some compromise language on that as well and Wyden relented. With the House Pro-Choice Caucus on board, I don’t think there is anything to worry about on this front.
As for the actual bill, it won’t be finalized until the Senate gets finished working on their amendments and the two bills are reconciled. Yet, early signs are encouraging. The most significant thing is simply that it ends the submental budget ritual known as the “Doc-Fix.” Doctor reimbursement levels will be accounted for in a sane manner.
It’s important that the Republicans agreed to raise more revenue– despite the bill’s price tag, it only appears to cost more money because the Doc-Fix will actually be on the books for a change. It also provides incentives to move doctors and hospitals into pay-for-performance programs, which is most likely going to be a positive legacy of the bill.
If there are any potential problems, one might be that the slow growth of reimbursement fees will cause fewer doctors to treat Medicare patients. Yet, I think it will be harder to exclude Medicare than Medicaid patients. On this score, we’ll have to wait and see.
The final vote of 392-37 was resoundingly bipartisan, and the signs are positive that the Senate will pass it easily, too.
I’m still a little stunned that this Congress was able to pull this off.
