The “doc fix” has become a strange legislative tradition as Congress regularly votes to stop the automatic cuts in physician payment called for under the flawed Sustainable Growth Rate formula. As I discussed in March, this time there were a couple of new twists which were known, but in addition it turns out that another item hidden in the bill reveals a lot about the Republican Party.
First I’ll recap what we had already known. The “doc fix” proposed to block the cuts which would have taken effect in April was for one year and included multiple other measures, including a delay in implementing change to ICD-10 diagnosis codes until at least October 2015. Physician groups actually opposed this bill because a permanent fix was also under consideration and it was feared that passing yet another temporary fix would lead to abandonment of the permanent fix (which does now appear dead).
The “doc fix” regularly passes with bipartisan support because Congress is not going to risk the backlash which would be created if many Medicare patients could no longer find physicians willing to accept them. This time the House passed the “doc fix” on a voice vote, which allows individual members to avoid being held accountable for the vote.
Over the weekend we learned why House Republicans wanted to pass this on a voice vote. Another item in the bill made some changes in the Affordable Care Act which was desired by small business and which Democrats were willing to make:
At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.
Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.
“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.
No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.
It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.
This shows how dysfunctional Congress has become. Normally both parties would see it as a victory for the system that they passed a measure to make requested changes in the Affordable Care Act. However, Republicans felt compelled to hide this vote because it contradicts their public policy of only supporting repeal (having voted for repeal over fifty times). Since this became public, the Republicans have faced criticism from the right, probably making it even harder for them to vote on improvements in the Affordable Care Act in the future.
The fix which passed allows small businesses to offer policies with higher deductibles. This allows for lower premiums, and the higher deductibles are often handled separately with Medical Savings Accounts. There are also added protections in new insurance policies under the Affordable Care Act such as annual limits on out of pocket expenses and the elimination of annual and lifetime caps on coverage which help offset the problems created by higher deductibles.
If Republicans should attack the Affordable Care Act based upon including high deductible plans, keep in mind that this is exactly the type of plan which Republicans frequently advocate, and that the Republicans voted to increase the allowable deductible levels in response to requests from small business. Democrats had no objection to the change as the limit on deductions was originally placed in the bill because it was supported by Republican Senator Olympia Snowe. In response to this addition, Snowe voted for the Affordable Care Act when in the Senate Finance Committee but ultimately voted against the bill on the Senate floor, along with every other Republican Senator.