Watch your wallet

A major deal struck between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) to overhaul Medicare appeared to win President Barack Obama's endorsement on Wednesday.

"As we speak Congress is working to fix the Medicare-physician payment system. I've got my pen ready to sign a good bipartisan bill, which would be really exciting," he said in a speech about Obamacare at the White House. "I love when Congress passes bipartisan bills that I can sign. It's always very encouraging."

The presidential endorsement could sway enough Senate Democrats, who have emerged as a potential obstacle, to support the agreement.

"We're just looking at it now," Sen. Chuck Schumer (D-NY) said moments before Obama's remarks Wednesday. "We'll see where we come out."

The deal would end the perennial "doc fix" problem by replacing a formula that imposes steep annual cuts to Medicare physician payments. The package would also cut Medicare benefits for higher-income seniors and reduce spending on supplemental "Medigap" plans. It would extend the Children's Health Insurance Program for two years.

If the legislation passes both chambers, it would amount to the most sweeping health care overhaul since Obamacare.

Republicans sure love it:

Rep. Paul Ryan (R-WI):

“Many of us have worked for a long time to repeal this flawed formula and replace it with a more patient-centered system. Now we have a chance to get it done. This package is the best opportunity to turn the page on years of short-term fixes so that we can finally make the reforms we need to strengthen Medicare for our seniors. This is real patient-centered reform—done in a bipartisan way—and I urge all of my colleagues to support it.”

Rep. Joe Pitts (R-PA):

“For years, the SGR has distorted Medicare’s finances and the federal budget. 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.”

Rep. Michael C. Burgess, M.D. (R-TX):

“It’s historic: fundamental structural changes in Medicare not sold on the back of a tax increase.”

Rep. Marsha Blackburn (R-TN):

“This legislation will provide actual, structural entitlement reform by changing the way healthcare providers are paid. Everyone agrees that healthcare reimbursement should encourage quality and coordination of care, rather than volume. This legislation is the right move in that direction. It is a win-win-win for seniors, your local healthcare providers, and hard-working taxpayers.”

Rep. Larry Bucshon, M.D. (R-IN):

“For the first time, real structural reforms that ensure access to quality care for seniors and help us protect the Medicare promise are within our grasp. Let’s build upon the unprecedented progress of last Congress, and solve this problem once and for all."

Rep. Chris Collins (R-NY):

“This is the type of substantive and cost-saving reform the American people elected us to enact. Repealing and replacing the SGR is a milestone achievement that will reduce long-term costs, increase quality of care and implement structural changes to Medicare.”

Rep. Brett Guthrie (R-KY):

“Now is the time to finally leave the flawed SGR formula in the past, and begin working on real reforms to our health care system that will improve care for seniors while putting the Medicare program on more sound fiscal footing.”

Rep. Renee Ellmers (R-NC):

“It’s time we in Congress do our job and show leadership by enacting permanent legislation to repeal and replace the flawed SGR formula. … Continually kicking the can down the road is only perpetuating Washington’s spending problem, while yet another SGR deadline quickly approaches.”

Rep. Kevin Brady (R-TX):

“The first concrete step in saving Medicare is solving the way it pays local doctors for treating our seniors. … Congress and the President could continue to duck the issue. They can simply ‘kick the can down the road’ by extending the current damaging doctor payment system for another year or two — as they have an astounding 15 times already. Or they can come together and pass a permanent solution now that encourages doctors to see Medicare patients and rewards them for providing quality care at affordable cost.”

Rep. Joe Barton (R-TX):

“I think it's good. We need some of the structural entitlement reform. That's a good thing. … I know how hard this is. Our seniors are having more and more difficulty getting doctors because Medicare doesn't reimburse, and doctors are dropping Medicare.”

Rep. John Fleming (R-LA):

“These are two huge improvements that would drive costs down and actually, in the long-run, improve care and access to care. This is a long-term solution for doctors who are having their patients really destroyed. ... This is a huge advance.”

Rep. Pete Sessions (R-TX):

“We must find a way to get it done, and will. ... The art of getting it done is in everyone's interest. ... I view it as a must-pass piece of legislation.”

Rep. Fred Upton (R–MI):

“We can see the light at the end of the SGR tunnel—finally. Our bipartisan product begins the task of strengthening Medicare over the long term. This responsible legislative package reflects years of bipartisan work, is a good deal for seniors, and a good deal for children too. It’s time to put a stop once and for all to the repeated SGR crises and start to put Medicare on a stronger path forward for our seniors."

The existence of a bipartisan permanent fix, coming out of the insane Republican House is remarkable. Also remarkable is the expectation that it will pass.

A floor vote is planned for Thursday, House leadership aides said, after the top Democrat and Republican successfully resolved concerns about abortion language.

"It is all shaping up very well on both sides," said Kevin Smith, a spokesman for Boehner.

Ah, but that "abortion language" is the kicker, and it's the reason that it is much less certain that the plan will pass the Senate. The nature of the "doc fix," a must-pass bill because it has two powerful constituencies—seniors and the medical community, means that it will be a magnet for other things. They can't resist tacking on a bunch of sweeteners, and those sweeteners end up being poison. That's the case here, when $7.2 billion for community health centers was added. That's great. Community health centers need to be funded. The problem is that Republicans insisted on anti-abortion Hyde amendment language being added to that funding, despite the fact that community health centers generally don't provide abortion and an executive action signed by President Obama when Obamacare passed makes doubly sure no federal funds will be used for abortion in these clinics.

House Democrats argue that it's okay to include the language because of those facts—it makes no difference. But the same argument could be turned against them—the anti-abortion language need not be included at all and is absolutely unnecessary. In fact, adding it—as Senate Democrats say—brings us that much closer to codifying the abortion ban in the law, as opposed to tacking it on as an amendment on spending bills. Accepting it means losing even more ground on choice, which so far Senate Democrats aren't willing to do.