If the proposal sounds familiar, it’s because the Senate considered a nearly identical bill just a month ago. That legislation was shot down, not because lawmakers oppose the underlying concept (nearly everyone on Capitol Hill agrees that Medicare’s physician payment formula doesn’t work), but because Democratic leaders didn’t offset the substantial costs with revenue increases or federal spending cuts. That is, the new spending would have been piled onto the country’s already considerable debt.

Fast forward a month and you might think that House Democrats would take a lesson from the failed Senate bill by offering to cover the costs. But you’d be wrong; the bill is unfunded.

Here’s House Majority Leader Steny Hoyer (D-Md.) tying himself in rhetorical knots yesterday as he tried to explain to reporters why the Democrats aren’t even trying to pay for their proposal.

In our budget we contemplated that the [cost] … would not be paid for. That doesn’t mean it doesn’t have to be paid for – clearly it does. We need to address the fiscal issues confronting us. On the other hand, [the doc fix] has been passed on a regular basis not being paid for.

Here’s what he was talking about. Earlier in the year, House leaders passed pay-as-you-go budget rules, but exempted four big-ticket (and enormously expensive) items that are deemed must-pass bills. The doc-fix was among them.

As a part of the pay-go exemptions, though, the Democrats said one of three things had to happen. Either statutory pay-go has to be law (it isn’t, because the Senate hasn’t passed it); the doc-fix proposal has to be paid for (it’s not); or statutory pay-go has to be attached to the bill as a rider (the House doc-fix bill does this, with the intention that the Senate would pass the requirement that everything other than those four items be paid for through the rest of the fiscal year).

Hoyer explains:

We think it is critical to combine this with a fiscally responsible policy of providing for all but the four specific items we exempted. All other items of spending on entitlements or reductions in revenues would be covered by statutory pay-go. … We think that fiscal discipline is critically important.

This, of course, is a cop out. That is, Congress created Medicare’s flawed pay formula, but no leader of either party seems to want the responsibility of finding ways to pay to fix it.

Also unmentioned here is the political strategy behind tomorrow’s House vote. For years, the American Medical Association, the nation’s largest doctor lobby, has pushed lawmakers to eliminate the doc-payment formula, which is indexed to GDP growth rather than to faster-rising medical inflation. AMA has announced its intention to support the Democrats’ health reforms this year, but they haven’t said they’d do so without the doc-fix accompanying the larger (and very separate) bill.

The House is expected to pass its doc-fix bill tomorrow. But there’s no good reason to think that that the budget hawks in the Senate would have had a change a heart about its cost over the past month. The question is, will the mere effort to pass the bill be enough to win the AMA’s support for the larger reforms? Some are already saying no.

“I don’t think we need to do another stimulus package,” he said. “All we need to do is move in regular order and do what we need to do for the country.”

Clyburn’s comments put him at odds** with other Democratic leaders — including House Majority Leader Steny Hoyer (D-Md.) and Senate Majority Leader Harry Reid (D-Nev.) — who see a new jobs bill as a necessary step toward curbing unemployment rates.

With those rates topping 10 percent last month — and with tough elections looming in 2010 — the smart money here is on Hoyer and Reid.

H/t: The Hill.

**Or not. Clyburn spokeswoman Kristie Greco emails to clarify that the congressman does in fact support job-creating legislation, including an extension of unemployment benefits, more COBRA subsidies and a fully funded, six year transportation bill, “which would create six million jobs,” Greco said. “I don’t see a difference between the Hoyer/Clyburn positions,” she added. It seems that Clyburn doesn’t view these items as “anything new.”

I think clearly we need to move on unemployment insurance and COBRA. Beyond that, you mentioned a couple: public jobs, job tax credits, infrastructure. There are a lot of options available; we are discussing those. We are discussing with economic advisors as to what is the most effective. And, frankly, there are differences of opinion on that.

Asked about the size of the jobs package, Hoyer offered no hints. “I don’t have a figure,” he said tersely.

Obviously, there may be different figures for different things that you do. But it is clear that we need to act in a way that does get to the creation of job opportunities for people in the short term. That is what we are trying for.

Of course, that’s also what Democrats were trying for when they passed their $787 billion stimulus bill in February, when unemployment was 8.1 percent. How many more business tax breaks does Congress have to pass before recognizing that well-targeted infrastructure spending — including money for public transit – just might offer more bang-for-the-buck?

The count was 403-12. The “nays” comprised mostly conservative Republicans who oppose the tiny employer surtax that will fund the benefit extension.

The bill will provide an additional 14 weeks of unemployment insurance in every state, with an extra six weeks going to folks in the 27 states where jobless rates have topped 8.5 percent.

“This means that they will be able to survive,” House Majority Leader Steny Hoyer (D-Md.) said before the vote. “Not thrive, but survive.”

The proposal also extends a popular $8,000 tax credit for new-home buyers, while allowing businesses to recover taxes they’ve paid in the last five years to compensate for more recent losses.

The bill now moves to the White House, where President Obama has vowed to sign it into law quickly, likely tomorrow.

After voting 85-2 yesterday to proceed to legislation extending unemployment benefits at least 14 weeks nationwide, the Senate remains stalled Tuesday over a second procedural vote required to move to final passage.

Delaying the bill are (1) Republican leaders insisting on consideration of unrelated amendments, and (2) Senate rules requiring two cloture votes to move to final passage of a bill originating in the House when Senate Democrats want to swap it out for a substitute proposal, as was the case here.

So yesterday’s cloture vote was on the Senate substitute bill, with a second needed to move to the (amended) House bill. That’s a long way of saying that the final vote will  come Thursday at the earliest, unless party leaders can reach an agreement beforehand.

Neither side, though, appears ready to budge.

Senate Majority Leader Harry Reid (D-Nev.) told reporters in the Capitol today that GOP leaders are stalling intentionally in order to prevent other Democratic priorities from reaching the floor.

“Even today they’re still stalling before we can pass this bill finally,” Reid said. “Perhaps Senate Republicans don’t think it matters to stall and delay, but it matters to the unemployed worker who so desperately needs this money.”

Democratic leaders first asked Republicans for their consent to pass the bill unanimously on Oct. 8. GOP leaders, however, refused that and subsequent requests, citing first the absence of a cost estimate, then the reluctance of Democrats to consider amendments on ACORN and illegal immigrants, and finally the Democrats’ refusal to vote on three other GOP amendments, including a provision to end the Wall Street bailout and another to fund the unemployment benefit extension with unspent stimulus funds.

Senate Minority Leader Mitch McConnell (R-Ky.) told reporters today that if Reid wants to pass the unemployment benefits quickly, he simply needs to agree to votes on those three provisions. Otherwise, McConnell said he has every intention of dragging the process out as long as he can.

“We could have passed this unemployment insurance bill last Thursday,” McConnell said.

I offered a consent agreement which would have given us a handful of amendments upon which we were prepared to take short time agreements, but the majority leader didn’t want to have to vote on more amendments.

So my view is, he doesn’t get to pick our amendments. What we were offering was totally reasonable. And he didn’t want to have — he didn’t want to have the votes.

Technically, the second cloture vote could come as early as 11:40 p.m. tonight, though that vote will likely be pushed to Wednesday morning. Afterward, without an agreement, Democrats would have to wait another 30 hours before staging the final vote, which will likely come Thursday afternoon.

The next stop would be the House, which passed a different unemployment bill in September. House Majority Leader Steny Hoyer (D-Md.) said Tuesday that chamber leaders will take up the Senate bill as soon as it arrives from the upper chamber.

“Why they had to wait a week to get the vote is beyond me,” Hoyer told reporters. “Having said that, we will consider the UI when it comes over.”

“We are still working on that,” Hoyer said, “but I am reasonably confident. I have talked to people who have varying views on that. I am pretty confident that we can get there, essentially making very clear that any money spent on the issue of termination of pregnancy will be spent, not by the government, but by the individuals.”

Moderate Democrats, behind Rep. Bart Stupak (D-Mich.), have voiced concerns that the House bill doesn’t go far enough to eliminate the possibility that federal funds could subsidize abortions, particularly for patients enrolled in plans on the exchange.

Hoyer said he hopes to bring the Democrats’ $894 billion proposal to the floor either Friday or Saturday of this week. “I am confident of prevailing before Veterans Day,” he added.

The House already passed pay-go legislation this year, exempting four expensive items — including the doc-fix — but only if one of three conditions were met. Either statutory pay-go has to be in law (the Senate hasn’t passed it); the doc-fix proposal has to be paid for (it’s not); or statutory pay-go has to be attached to the bill as a rider.

Hoyer explained the strategy Tuesday.

In consideration of those exceptions, you must pass and put in place statutory pay-go so that we cannot do it for other things. So we can take some very substantive, important steps forward in bringing fiscal discipline to this nation, which needs it.

They’ll have some time to work things out. The Senate, which was expected to take up the doc-fix bill Tuesday, has delayed the floor debate while chamber leaders continue to negotiate amendments.

No, no, look, the reality of it is when I ran for the United States Senate and I was called an Uncle Tom by leading Democrats in the country, when I was called a slave by Steny Hoyer who is now the majority leader in the House, no one came running to my defense, and no one seemed to think that that was racist at the time. I don’t play the race card, I don’t play the race game, the way some tend to want to do.

There are a number of slippery allegations here. The first is the charge that “leading Democrats” called Steele an “Uncle Tom,” which is just false, unless the term is extended to cover liberal bloggers. The second, more directly false charge is that Steele was “called a slave by Steny Hoyer,” that “no one came running” to defend him. What happened was that Hoyer, in the final month of the campaign, characterized Steele’s record as “a career of slavishly supporting the Republican Party.” Steele, at the time, was running uphill in a deep blue state by declaring his independence from the parties. He pounced on Hoyer.

It goes to just the sheer craziness of some in the Democratic Party who think they can use racist terms and infer things about me just because I’m an African American Republican.

Then he got back-up from Rev. Anthony Evans of the National Black Church Initiative.

If I did not know Rep. Steny Hoyer, I would say that he is a racist.

Rather quickly, Hoyer apologized.

I shouldn’t have used those words. If Mr. Steele did in fact take offense let me assure him that none was intended.

The affair became a national news story. The Washington Times did a follow-up in which the paper asked black leaders whether they’d denounce Hoyer.

So, to recap: Hoyer said that Steele “slavishly” supported the Republican Party, and Steele called this a racist comment while Republicans rounded up spokesmen to call Hoyer a racist. Three years later, Steele claims that he was “called a slave” by Hoyer, and that “no one seemed to think that that was racist at the time.”

Yet if Rep. Nancy Pelosi (D-Calif.) has anything to say about it (and she does), that plan might not fly. In April, the House speaker, along with House Majority Leader Steny Hoyer (D-Md.), penned a letter to congressional budget leaders promising to withhold their support this year for four different bills — middle-income tax cuts, the estate tax,  relief from the alternative minimum tax, and an increase in Medicare payments to physicians — unless the new spending is offset by cuts elsewhere or increased revenues.

The House will not consider any conference reports on these four bills or any of them directly from the Senate unless these conference reports or bills include statutory PAYGO, the bills are fully offset under traditional scorekeeping, or statutory PAYGO has already been enacted into law.

Today, Pelosi was asked if she stands by the letter. She responded with one word: “Yes.”

Complicating the issue, Hoyer told The New York Times this week that, regarding the doc-fix, he’s not feeling terribly bound to his earlier proclamation that it be paid for.

On this issue, Mr. Hoyer said, “There is a difference between the Senate and the House, and it is a pretty substantial difference.”

Asked whether the House would offset the cost of its proposal, he said, “I don’t think we are going to pay for it.”

Goes to emphasize that the thorniest disputes in this health reform debate have yet to be resolved.

“Secretary Gates still believes General McChrystal’s focus right now should be on managing the war in Afghanistan rather than wading into the debate about it back here in Washington. There may be a time when he can add to the discussion beyond what his assessment already has, but the first order of business is for the President and his national security team to carefully consider the assessment and the way ahead. The department is working closely with Congressional defense committees to keep them informed of this process as it unfolds and our discussions with them will also determine what makes sense in terms of further briefings or even hearings once the President’s review of the assessment has been completed.”

In an email, aides to Sen. Carl Levin (D-Mich.), the chairman of the Senate Armed Services Committee, say the senator agrees. From Levin spokeswoman Tara Andringa:

Senator Levin has said that calling General McChrystal, General Petraeus, and Admiral Stavridis in to testify at this stage would be premature.  He has said that he will call military and civilian witnesses to testify before the committee once commanders in Afghanistan have made their recommendations, which they have not yet made, and after the recommendations have been reviewed by the chain of command.

Gates is the one who ultimately makes Defense Department witnesses available to the congressional committees, as McChrystal’s spokesman, Lt. Col Tadd Sholtis, underscored earlier.