Republicans Open to Potential ‘Doc Fix’ Deal

Pitts was optimistic about a long-term "doc fix" deal. (Bill Clark/CQ Roll Call File Photo)
Pitts was optimistic about a long-term "doc fix" deal. (Bill Clark/CQ Roll Call File Photo)
Posted March 16, 2015 at 9:52pm

As Congress approaches another deadline, lawmakers seemed hopeful Monday evening they could do something increasingly rare: take off their can-kicking shoes and make a deal.  

Aides told CQ Roll Call that Speaker John A. Boehner was set to give the Republican Conference an update on the “bipartisan discussions” regarding the Sustainable Growth Rate during the GOP’s weekly meeting Tuesday morning. And the prospect of reaching an elusive long-term deal on the payment formula for doctors and medical professionals accepting Medicare was looking better and better. “For years, the SGR has distorted Medicare’s finances and the federal budget,” Joe Pitts, R-Pa., chairman of the Energy and Commerce Health Subcommittee, said in a statement Monday night. “We’re now very close to permanently replacing it and passing some real Medicare reforms that will have a lasting impact. There’s a lot for conservatives to like here.”  

The details of a long-term deal haven’t been released, or even completely negotiated. But members seem receptive to the idea that a compromise would not be entirely offset. The argument goes, because Congress routinely extends SGR without paying for it anyway, any savings Republicans could extract from a so-called “doc fix” would be a win.  

It just depends on your perspective of a baseline.  

Do you start from the assumption that Congress will adjust the Medicare payment formula without offsets, or do you begin by assuming that any change to current law needs to be paid for? While the latter position has been the historical one for fiscal hawks, even some of the most conservative members in the GOP conference see some merit to the other position.  

“It’s a fair point,” said House Freedom Caucus Chairman Jim Jordan. “Because it is a little sort of — been kicked along forever. And now if we’re actually going to offset some of it with real savings, that’s something we got to look at.”  

The Ohio Republican noted that, “obviously,” conservatives believed an SGR deal would be better if it were paid for. “But we want to look at it,” he said. “We want to see what is paid for.”  

That Jordan isn’t outright dismissing a deal is something — and it’s proof that arguments from Americans Tax Reform and even the Wall Street Journal editorial page  are seeping into the conservative consciousness.  

Ryan Ellis, the tax policy director for ATR, said leadership and committee staff working on the deal had repeatedly assured him the proposed bill would be “totally paid for, and then some — just not by the end of the 10-year window.”  

“But since when do we measure entitlement reforms with 10-year windows?” Ellis asked in a statement.​ “The Medicare actuaries report uses a 75-year time horizon, for example. Entitlement reform is slow and gradual to be fair to current seniors who can’t adjust. But the savings grow like an avalanche over time.”  

Of course, not every member is prepared to accept this idea of future savings and a nebulous SGR baseline.  

“America’s speaking very, very loud. And we need to listen,” Paul Gosar, R-Ariz., told CQ Roll Call Monday night. “They said stop this president. They didn’t say sing Kumbaya with the other side.”  

Gosar said the numbers on a deal just didn’t add up. And he didn’t expect Boehner to incur the potential wrath of conservatives by cutting a deal with Democrats that cuts conservatives out of the discussion. “I don’t think he can afford to do that,” Gosar said.  

But what happens if Boehner does it anyway?  

“Stay tuned,” he said.  

Boehner almost certainly could pass a deal with Democrats and a healthy majority of the GOP conference. Democrats seem to want an extension — maybe two years, maybe four years — of the Children’s Health Insurance Program. Republicans want some spending concessions on the Medicare payment system. Conservative Rep. John Fleming, who said he’d been briefed on the emerging deal, told CQ Roll Call he thinks he’ll be able to vote for an eventual deal. “We’re being honest for the first time,” the Louisiana Republican said. “This has all been a shell game for over a decade.”  

Still, this is Congress: the New York City street corner of shell games. And these are lawmakers: the Ray Guys of legislative punting. If there’s anything Congress is particularly skilled at, it’s finding a way to sour the big deal in favor of the short-term bargain.  

SGR is no exception.  

Congress has opted for a “patch” 17 times in a row on the “doc fix.” And Boehner, who is still reeling from the Department of Homeland Security funding battle where Republicans caved on not blocking President Barack Obama’s executive action on immigration, could see some political expediency to a shorter deal that allows Congress to address this issue later. A final decision may just depend on the backlash he faces from conservatives.  

“Be careful what you ask for,” Gosar said ominously when asked about Boehner potentially disregarding conservatives.  

“I’m sure there’s a line in that sand,” he added, noting that he was on his way to a Monday evening HFC meeting where SGR would certainly be a topic of conversation.  

Melissa Attias contributed to this report.

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