WASHINGTON—The overwhelming and bipartisan vote in the House to permanently repeal Medicare's sustainable growth-rate formula puts pressure on the Senate to act before adjourning Friday. But it's not certain that they will given the narrow window and the need to also pass a budget before leaving town for spring break.
Sen. Jeff Sessions (R-Ala.), an influential conservative, spoke out against the deal in a floor speech on Thursday, signaling potential trouble. “Why would we allow this to pass through so fast?” Sessions asked. “Let's do a short-term fix again. But this time let's do a permanent fix, one that's responsible, one that's grown-up, one that's paid for, not just one that adds more debt to the credit card of America.”
However, Sessions delivered that message before the vote in the House, which passed the doc-fix bill by a 392-37 margin, an extremely rare show of bipartisan support on a major piece of legislation. Republicans largely ignored the vehement opposition from conservative advocacy groups such as Heritage Action for America.
Stephen Northrup, a partner at the Rampy Northrup lobbying firm and former GOP Senate staffer, said the Senate should be able to get unanimous consent to bypass the rules and pass the bill after the overwhelming show of support in the House. “No one is going to want to be the one out of 100 that stands up and blocks this,” Northrup said.
"I think it's going to pass, but I don't know when," said John Rother, president of the nonpartisan National Coalition on Health Care, noting that the CMS has some flexibility in when it implements the rate cut for doctors. "It's not a hard deadline."
But Sessions could prove to be an impediment. Another potential holdout is freshman Sen. Ben Sasse (R-Neb.), who wrote an op-ed in Politico urging the House to reject the deal on the grounds that it is fiscally irresponsible.
Senate Democrats have been pushing for a four-year extension of the Children's Health Insurance Program, as opposed to the two-year extension in the House bill. But they're not expected to block consideration of the legislation over that issue.
Bruce Lesley, president of First Focus, an advocacy group focused on children's healthcare, insisted that they haven't given up hope on still getting a four-year extension adopted in the Senate. “Two years is certainly better than nothing. We're happy that the House moved forward,” Lesley said. “There will be time for us to at least raise the issue.”
If the Senate fails to act before adjourning, the CMS would have some wiggle room to avoid an immediate 21.2% cut in Medicare payments to doctors. By holding onto claims, they could forestall payments until after Congress reconvenes on April 13.
But negotiations to avoid that scenario are now underway, said a Senate staffer who works on the SGR issue, speaking on background. “Can you work out a deal where they allow a vote and do it quickly?” this person asked. “I don't think (unanimous consent) is possible, but I think most members are going to say we're not going home (until we pass this).”