House Approves Bill on Changes to Medicare
By JENNIFER STEINHAUER and ROBERT PEAR
MARCH 26, 2015 - New York Times
WASHINGTON — The House
overwhelmingly approved sweeping changes to the Medicare
program on Thursday in the most significant bipartisan policy legislation to
pass through that chamber since Republicans regained a majority in 2011.
The measure, which would establish
a new formula for paying doctors, increase premiums for some Medicare
beneficiaries and extend a popular health
insurance program for children, has already been endorsed by President Obama
and awaits a vote in the Senate.
The legislation, approved in the
House by a vote of 392 to 37, embodies a rare and significant agreement
negotiated by Speaker John
A. Boehner and the House Democratic leader, Representative Nancy Pelosi of
California. Both saw the value in ending a problem that has bedeviled the
nationfs health care system for more than a decade, and in demonstrating that
the nationfs legislative branch could function.
Mr. Obama called Mr. Boehner and
Ms. Pelosi to congratulate them after the vote. gThis is how Congress is
supposed to work," Mr. Obama said, addressing students at a community college in
Birmingham, Ala.
Lawmakers could not immediately
recall the last time a bill of such consequence had passed with a huge majority
in the era of divided government, when merely keeping federal agencies from
shutting down counts as a major achievement.
gNormally wefd be here to admit
that we are going to kick the can down the road one more time,h Mr. Boehner
said. gThis is what we can accomplish when wefre focused on finding common
ground.h
Marilyn Moon, a health economist
and former trustee of the Medicare program, said the vote Thursday had
far-reaching implications. gIf doctors respond to the incentives in this bill,
they will have to change the way they do business,h Ms. Moon said. gNow doctors
get paid more if they do more. In the future, they will be paid more if they do
it better — and may be paid more for doing less.h
Whether the bipartisan
accomplishment represents a passing moment of harmony or signals a new period of
cooperation remains to be seen. Many other issues, like the expiration of
highway funds and an ambitious rewrite of the tax code, await.
Mr. Boehnerfs strategy of working
out a significant legislative compromise with Ms. Pelosi was a break from his
prior attempts to mollify his most conservative House colleagues. gWe are
showing that we have a majority thatfs working,h said Representative Paul D.
Ryan, Republican of Wisconsin, gand when we see opportunities to find common
ground, we are moving forward on big things.h
For her part, Ms. Pelosi, who
turned 75 on Thursday, again demonstrated that even as the leader of a minority
party that is sometimes restless for fresh leadership, she could win policy
fights for Democrats while persuading them to compromise. Mr. Boehner lost just
33 Republicans on the bill, and only four Democrats voted no.
Democrats were pleased that the
bill extended some of their favorite programs and did not attempt to roll back
the Affordable Care Act, as Republicans have repeatedly tried to do. Republicans
felt they had won because, as Mr. Boehner said, the bill made a start on greal
entitlement reformh without the tax increases often sought by Democrats.
Under the bill, Medicare would pay
doctors based on their performance, rewarding them for higher-quality work
rather than the volume of services. The Childrenfs Health Insurance
Program would be extended for two years, rather than the four years sought by
Democrats. More money also would be appropriated for community health centers,
with a restriction for abortion
services.
To help offset the costs, some
higher-income Medicare beneficiaries would be required to pay higher premiums
for coverage of doctorsf services and prescription drugs. But about two-thirds
of the costs would be added to the deficit. The Congressional Budget Office
estimated that the bill would add $141 billion to federal
budget deficits in the coming decade, compared with existing law.
Members of both parties went to
the House floor on Thursday for what was officially a debate, but sounded more
like a wedding, with lawmakers speaking of the measure as benefiting elderly
Medicare patients, children and taxpayers.
gItfs not a perfect bill,h said
Representative Ami Bera, Democrat of California, who is a physician. gBut I came
to Congress to put people first. I came to Congress to work across the aisle in
a bipartisan way to put our country first.h
Senate Democrats have been
resistant to provisions in the bill that preserve restrictions on the use of
federal money for abortion services and extend the Childrenfs Health Insurance
Program for only two years, rather than four. House Democrats who also disliked
those provisions said they got the best they could. Senator Debbie Stabenow,
Democrat of Michigan, said: gThat certainly was a big vote in the House. We need
to look at the details.h
The lopsided vote in the House
will probably help bring along members of both parties in the Senate, which is
unlikely to vote before a two-week recess scheduled to start Friday. gI think
wefll have the votes,h said Senator Patrick J. Toomey, Republican of
Pennsylvania.
Several conservatives expressed
concern about the billfs effects on the deficit, including Senator Ben Sasse, a
freshman Republican from Nebraska, and Senator Tim Scott, Republican of South
Carolina, who said the bill gis exciting for someone but not necessarily me.h
Doctors face a 21 percent cut in Medicare fees on April 1 unless Congress takes
action. Such a reduction would almost surely prompt some doctors to accept fewer
Medicare patients. Medicare officials could stretch the deadline and delay the
cuts for about two weeks.
Since 2003, Congress has passed 17
short-term bills to block cuts in Medicare doctorsf fees, which are calculated
under a formula that defines a gsustainable growth rateh linked to growth of the
overall economy. The Boehner-Pelosi bill repeals that formula.
Representative Michael C. Burgess,
Republican of Texas and chief sponsor of the legislation, said, gFrom beginning
to end, this bill is about access — access for our seniors, access for those who
use our nationfs 9,000 community health centers and more than eight million
children who receive their care at some point during the year through the
Childrenfs Health Insurance Program.h
Michael D. Shear contributed reporting.