The vote was 238-181, with most House Democrats refusing to
swallow what they called an Obamacare "poison pill," a provision to
delay for five years the tax penalty that most Americans must pay
under President Barack Obama's healthcare law if they decline to
sign up for insurance.
Just a dozen Democrats, some of whom face tough re-election races in
November, voted with Republicans to pass the bill, which the White
House has threatened to veto.
Hundreds of thousands of doctors who participate in traditional
Medicare face a 24 percent pay cut on April 1, a situation dating to
a 1990s initiative to restrain federal spending on the government
healthcare program, which today serves nearly 50 million elderly and
Doctors hoped to see a permanent fix to the recurring Medicare
payments problem this year after Republicans and Democrats in both
chambers of Congress agreed in February on a policy to replace the
payment formula, known as the sustainable growth rate, or SGR.
But there was no agreement on how to fund the $138 billion cost of
the "doc fix" over the next decade. So House Republicans proposed to
pay it by delaying the penalty for the individual mandate to buy
insurance under the Affordable Care Act, also known as Obamacare.
Democrats charged this was part of a Republican election-year attack
strategy on the 2010 law, noting it was the 51st vote in the House
to repeal or undermine Obamacare.
Some analysts also noted that the vote will let Republicans accuse
Democrats of refusing to help Medicare doctors in order to keep one
of Obamacare's most unpopular provisions intact. This could menace
vulnerable Democrats in states where public attention on healthcare
reform has been directed toward last year's wave of insurance
Republicans "have created a very strong issue here. Politically,
you're talking about getting rid of something unpopular to pay for
something that's very popular," said Robert Blendon, a Harvard
University professor who studies political trends in healthcare.
The individual mandate penalty, which underpins the terms of
subsidized private health coverage available through new Obamacare
insurance marketplaces, is being phased in over three years. For
2014, it amounts to $95 per adult or 1 percent of household income,
whichever is greater. For 2016, it rises to $695 per adult or 2.5
percent of household income.
Delaying the penalty until 2019 would slow down Obamacare signups
and save the government billions of dollars that would otherwise be
paid out in taxpayer subsidies to enrollees, the Republicans say,
citing Congressional Budget Office estimates.
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Democrats expressed consternation that Republicans would attach
their latest Obamacare attack to a bipartisan compromise to fix
Medicare payments that had eluded lawmakers for years.
"For what reason have you poisoned his process?" demanded Democratic
Representative Frank Pallone. "You have singled-handedly, in my
belief, stomped on months and months of hard work and effort by my
colleagues on both sides of the aisle and our staffs."
Republicans acknowledged the combined measure may not have a bright
Senate future but said they had to fund the doc fix to get it
through the House. They said Senate Democrats should propose their
own way to pay for the Medicare changes and then negotiate with the
However, while reforming the Medicare payments system is a priority
for many in the Senate, key Democrats like the new chairman of the
Finance Committee, Ron Wyden, have not proposed a way to pay for it.
"I think he has been open to the idea of the doc fix not paid for,"
Wyden spokesman Ken Willis said.
The House Republican approach brought an unusual public rebuke from
the American Medical Association, one of the most powerful lobby
groups, representing 225,000 physicians who hope for a permanent doc
fix this year. On Friday, the president of the AMA, Dr. Ardis Dee
Hoven, said it was "a shame" to see lawmakers' bipartisan efforts
overcome by "partisan politics."
Earlier this week the House passed exceptions to the Obamacare
individual mandate for veterans and firefighters, and broadened a
religious exemption. Last week 27 House Democrats voted to delay the
mandate penalty for one year.
But on Friday, one of those Democrats, Representative Carol
Shea-Porter, said she couldn't support a five-year delay because it
would seriously undermine Obama's healthcare law.
(Additional reporting by David Morgan; editing by Stephen Powell and
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