The Washington PostDemocracy Dies in Darkness

Hours from deadline, bipartisan Medicare bill heads to White House

Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker John A. Boehner (R-Ohio) formally take full congressional control on Jan. 6. (AP)

America's doctors can rest easy: Not only has Congress ensured they will be paid in full for the services they render to Medicare patients, it has ended the yearly ritual putting that in doubt.

The Senate voted 92-8 to approve a long-term "doc fix," as the legislation adjusting Medicare fees has long been known, less than three hours before federal officials would have reduced payments to health-care providers by 21 percent. President Obama has indicated that he will sign the bill, which also extends the federal Children's Health Insurance Program, a key Democratic priority.

Despite the last-minute nature of the vote, it was lauded by Hill leaders as a bipartisan triumph for both removing a yearly headache from the legislative calendar but also by implementing modest reforms to Medicare, including future incentives for doctors to deliver better care as well as premium hikes for the wealthiest Medicare recipients.

[Congress congratulates itself for the ‘doc fix’ deal, but can it happen again?]

“Instead of kicking this important Medicare payment issue down the road again, a strong bipartisan majority in Congress voted to finally solve the problem and ensure that seniors on Medicare don’t lose access to their doctors," Majority Leader Mitch McConnell (R-Ky.) said in a statement.

Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, said the vote was "a milestone for the Medicare program" for unraveling a "common-sense-defying" reimbursement system.

McConnell called Tuesday night's vote "another reminder of a new Republican Congress that’s back to work," but it could not have happened without support from top Democratic leaders. The deal was forged last month in the House, in a bargain struck by Speaker John A. Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) to eliminate the yearly "doc fix" votes while implementing some cost-cutting reforms to Medicare and extending the children's insurance program.

The bill passed the House 392 to 37 on March 26. The Senate did not act on the bill before leaving the next day for a two-week recess.

The "doc fix" has been necessitated by a 1997 legislative provision known as the Sustainable Growth Rate, which mandated that Medicare fees could not exceed the growth in the overall U.S. economy. But as actual health-care costs have far outstripped the fee hikes allowed by the 1997 legislation, Congress has been forced to step in on a yearly basis to reset the rates or risk the possibility that many health-care providers would stop treating Medicare recipients.

Before the final Senate vote Tuesday, senators rejected six amendments, the adoption of any of which would have sent the bill back to the House, busting the midnight deadline. The Centers for Medicare & Medicaid Services said earlier this month that it would begin processing cut-rate payments to doctors starting Wednesday.

The bill passed over the objections of the Senate's most conservative senators, who pushed colleagues to pay for the $141 billion in net spending that the Congressional Budget Office estimates the bill will create over the next decade. Sen. Mike Lee (R-Utah) accused his Republican colleagues of hypocrisy for touting a budget resolution that will balance the federal budget by 2025 while passing a Medicare bill that will undermine that goal.

[Ted Cruz & Co. stand athwart bipartisan ‘doc fix’]

Sen. Ted Cruz (R-Tex.), a presidential candidate, said in a statement Tuesday that any deal ending the "doc fix" should be "fully paid for and include significant and structural reforms to Medicare that provide seniors more power and control over their health care."

An amendment offered by Sen. John Cornyn (R-Tex.) would have offset the additional spending by repealing the health-care individual mandate -- the cornerstone of President Obama's Affordable Care Act. That measure went down along party lines in a vote requiring a 60-vote majority, with no Democrats or independents joining the Senate's 54 Republicans.

Republicans, meanwhile, banded together to defeat Democratic amendments that would have doubled the children's health insurance extension from two years to four, eliminated abortion restrictions in the bill and beefed up funding for women's health, and eliminated a cap on Medicare coverage for physical therapy.

Eight Republicans opposed final passage: Cruz, Lee, David Perdue (Ga.), Marco Rubio (Fla.), Ben Sasse (Neb.), Richard Shelby (Ala.), Jeff Sessions (Ala.) and Tim Scott (S.C.).

While Cruz and Rubio opposed the bill, a third presidential hopeful, professional ophthalmologist Rand Paul (R-Ky.), supported it.