POLITICS

Pelosi, Boehner Rekindle Bipartisanship With $214 Billion Medicare Deal

03/25/2015 07:36 pm ET | Updated Mar 26, 2015

WASHINGTON -- It's almost like seeing a unicorn run through Congress.

House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) have teamed up on a bill, and it's a biggie. It would fix a massive funding gap in Medicare, extend health care for poor children and make long-term spending cuts.

The $214 billion package, called the Medicare Access and CHIP Reauthorization Act of 2015, has a little something for everyone. Both parties are eager to tackle its core piece, which would permanently replace the so-called Medicare "doc fix" -- an annual vote to stave off cuts to the rates that doctors get paid by Medicare -- with gradual raises to doctors. Democrats like the bill's plan to extend the Children's Health Insurance Program for two years. Republicans like its $70 billion offset, which stems from structural changes to Medicare, like requiring high-income seniors to pay more and reducing spending on Medigap plans.

Boehner and Pelosi have been quietly hashing out details for weeks. They've spent the past couple of days building support in their caucuses, and on Wednesday, the White House issued a formal statement backing it.

"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," President Barack Obama said at a health care event earlier Wednesday. "I love when Congress passes bipartisan bills that I can sign."

The proposal marks a significant break for a Congress that's become so partisan that passing a resolution naming a post office is a major accomplishment. It's also a sign of the changing dynamics on Capitol Hill, where Democrats no longer control the Senate: A bipartisan bill hatched in the House has presidential support before many in the Senate have even read it.

The bill began its climb forward Wednesday afternoon, when the House Rules Committee voted unanimously to tee it up for a Thursday floor vote. Lawmakers seemed surprised, but relieved, that such a bill is actually moving.

"It's a rarity that I appear before the Rules Committee on the same side as Speaker Boehner," said Rep. Frank Pallone (D-N.J.). "I'm very happy to be here."

"This is something we all talk about, but we need a lot more of around here, which is genuine bipartisanship. Genuine effort to reach a deal," said Rep. Tom Cole (R-Okla.). "I'm proud of our speaker. I'm proud of our minority leader."

Even fiscal hawks have something to be happy about with the massive spending bill. Despite increasing the deficit by $141 billion over 10 years, it costs less than keeping the current system in place and it increasingly saves money after 10 years, per the Congressional Budget Office.

The bill is likely to sail through the House late Thursday. But its fate is less clear in the Senate, where Democrats are unhappy with some of its details and unclear on whether they'll support it.

"I'm looking for a longer extension of CHIP and funding for community health centers to be part of the mix," said Sen. Chris Coons (D-Del.). "I think it is important for us to bring some long-term stability to the funding of Medicare … but doing it in a way that is not paid for and that increases the burdens on beneficiaries without increasing benefits for low-income or working poor, I think shows the wrong blend of values."

Sen. Tom Carper (D-Del.) is among several Democrats pushing for a four-year extension of CHIP. Asked if he could support a two-year extension, he said, "I'd prefer four to two. We'll see."

"I would like to see four years," said Sen. Tammy Baldwin (D-Wis.).

Other Democrats are unhappy that the bill subjects community health centers to the Hyde Amendment, a 1976 provision that bars the use of federal funds for abortions, except in cases of rape or incest. Some Democrats want the provision removed altogether, but Pelosi maintains the language is routine and will expire after two years. The House Pro-Choice Caucus gave the bill its blessing.

Sen. Patty Murray (D-Wash.), a vocal proponent of abortion rights and the top Democrat on the Health, Education, Labor and Pensions Committee, "continues to talk to her colleagues about the best path forward," said her spokeswoman.

Most Democrats approached by The Huffington Post said they want to read the 200-page bill before making a decision. Senate Minority Leader Harry Reid (D-Nev.) said as much when asked about it Tuesday.

"I personally am going to wait until we see it having passed the House before we start speculating what we need to do with it, if anything," said Reid.

Senate GOP leaders have been mostly quiet on the bill, too. But key Republicans seem ready to support it.

"I can't imagine another bipartisan opportunity like this coming around again anytime soon," said Sen. Orrin Hatch (R-Utah), who chairs the Senate Finance Committee. "Anyone who thinks we can continue to put this off, to wait around for that perfect bill to come together, is fooling themselves."

Time is short. The current "doc fix" expires on March 31, which means, barring congressional action, doctors will face a 20 percent payment cut from Medicare. Add to the mix that Congress is heading into a two-week recess on Friday, and the House isn't expected to vote out the bill until Thursday. That leaves the Senate a tiny window to do something.

A top Senate Democratic aide speculated the Senate may either act late Thursday -- possibly with a quick "unanimous consent" agreement, if nobody opposes the House bill -- or punt the vote until after senators come back. That would mean Congress blows the March 31 deadline, but the Centers for Medicare and Medicaid Services has in the past found ways to avoid immediate cuts to doctors' payments.

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