Changes to entitlement programs rarely attract strong bipartisan support, but on Tuesday the U.S. Senate approved a bill to change how Medicare sets reimbursement rates for doctors by 92 votes to 8 (roll call). All of the no votes came from Republicans, but Iowa Senators Chuck Grassley and Joni Ernst both supported the bill. Follow me after the jump for background and details.
As Bleeding Heartland discussed here, the main goal of the Medicare Access and CHIP Reauthorization Act of 2015 was to end the “doc fix” habit in Congress. Since Congress adopted an ill-advised “sustainable growth rate” formula in 1997, lawmakers have approved seventeen short-term bills to stop big cuts to reimbursement rates for doctors serving Medicare patients.
In addition, the bill will “extend funding and current policy for the Children’s Health Insurance Program (CHIP) and several expiring Medicare and Medicaid provisions for two years.”
When the U.S. House approved the measure (also by a large bipartisan majority) in late March, Iowa Republicans Rod Blum (IA-01) and Steve King (IA-04) voted no, while Republican David Young (IA-03) and Democrat Dave Loebsack (IA-02) voted yes.
Before yesterday’s vote on final passage, senators rejected several proposed amendments to the bill. Grassley and Ernst both voted for a failed attempt to add language to the bill that would repeal the individual mandate to purchase health insurance under the 2010 Affordable Care Act.
Then Grassley and Ernst voted for a failed effort to “strike the provision excluding the budgetary effects of the Act from PAYGO requirements.” Those requirements force Congress to come up with either revenue increases or spending cuts to compensate for a given bill’s expected costs. The Congressional Budget Office estimated that this bill would add about $141 billion to the federal deficit over the next ten years.
Next to go was a Democratic proposal aimed at improving women’s access to health care. The whole Republican caucus, including Grassley and Ernst, rejected that motion.
A Republican amendment that would have changed the language on doctors’ reimbursements rates garnered only 11 yes votes, mostly from senators considered to be on the “tea party” wing. Both Grassley and Ernst were among the 89 senators who rejected that amendment.
Iowa’s senators also helped vote down a Democratic proposal related to outpatient therapy services.
Just before the vote on final passage, Senators agreed by 71 votes to 29 to waive budgetary discipline with respect to the Medicare deal; in other words, to allow this bill to add to the deficit. Grassley and Ernst both voted against that motion.
However, any concerns about adding to the deficit were not strong enough to deter Grassley and Ernst from supporting the bill. As mentioned above, they were among the 92 senators who voted yes on final passage.
Among senators who are running for president, Rand Paul voted for the Medicare deal, while Ted Cruz and Marco Rubio voted against it.
I haven’t seen any official comment on this bill from Grassley’s office, but Ernst released this statement on April 14:
WASHINGTON, D.C. – U.S. Senator Joni Ernst (R-IA) released the following statement after voting for the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) containing a permanent “doc fix” to replace Medicare’s Sustainable Growth Rate (SGR) formula for physician reimbursement:
“Congress cannot continue its pattern of band-aid fixes for a fragmented Medicare payment system that fails to address the underlying issue. While this bipartisan reform legislation is not perfect, and I would have much preferred that its spending was fully offset, it does move us in the right direction by strengthening Medicare and starting the process of necessary entitlement reform.
“I supported amendments that would have mandated this bill’s spending be offset, but regrettably they did not pass. However, I ultimately made the decision to support this bill because it will provide the much needed certainty and stability that our seniors, doctors, and rural community health centers deserve.”