Pelosi: Medicare Doc Fix Must Be Paid For
Yesterday, Senate Democratic leaders began moving on a proposal to scrap the current formula dictating doctors’ Medicare rates and replacing it with a system more accurately reflecting the costs to treat those patients. Notably, party leaders appear poised to pass the bill separately from broader health reform legislation in order not to upend President Obama’s vow that the reform bill will be 100 percent paid for. Translation: they don’t want to be forced to locate offsets for the $230 billion doc-fix bill.
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.