The Backdoor Bill: HR 4302 Passes

Back-room dealings at the House, a dubious voice vote, and 64 Senators voted Aye to pass H.R. 4302, surprising the industry and many legislators alike, temporarily halting cuts to doctors’ payments from Medicare, delaying ICD-10 implementation for a year, and extending a limited moratorium on post-payment review of inpatient hospital claims by RACs related to the controversial 2-Midnight rule.

The House surprisingly passed H.R. 4302 by voice vote, last Thursday, March 27, after some kind of deal was made on Wednesday between House Speaker John Boehner, R-Ohio, and Senate Majority Leader Harry Reid, D-Nev.

House Budget Committee chairman Paul Ryan, R-Wis., exclaimed, “They voiced it? My God!” while walking onto the floor on Thursday, after the deal between Boehner and Reid forced the bill through without a single member having to go on record as voting for or against the bill that seemed to only be seen as a way to stop cuts in the the Sustainable Growth Rate (SGR) – just as it has been done 17 times before.

Thursday morning, the bill’s passage was in doubt for a short time, as key House Democrats were speaking against the bill, and it was to be voted on under suspension of the rules, meaning it needed a two-thirds majority to pass rather than a simple majority. Therefore, to pass, a fair number of Democrats would have to vote for the bill, which was authored by Republicans.

Rep. Sandy Levin, D-Mich., top Democrat on the Ways and Means Committee, said, “We deserve better and we need to do better.” Also, groups like the American Medical Association (AMA) had come out against the bill because it wanted a more permanent fix to the SGR.

House Minority Whip Steny Hoyer, D-Md., was outraged, calling the patch, “…a fraud – and both sides have committed that fraud.” He wanted to see a permanent fix, further stating, “What a lamentable fact we cannot summon the courage and wisdom to do just that.”

House Minority Leader Nancy Pelosi, D-Calif., said in her weekly press conference that the bill was indeed “a bad choice, but it’s the only choice we have.” She stated she would be voting in support of the bill. According to Pelosi, the Republicans wanted to suspend the rules in order to allow a voice vote, because they simply didn’t have enough votes to pass it – they needed 218 – and were hoping Democrats would push it the rest of the way through. Apparently, she feared that, “if they don’t have the votes” the Republicans would “blame it on us that this didn’t pass.”

Whatever the circumstances, the debate on the SGR fix ended without a single word being said publicly about ICD-10 and the 2-Midnight Rule, which were both part of the bill. The House leadership huddled into some closed-door meetings, and a new deal was struck. Members returned, the rules were suspended, and the bill was allowed to pass by voice vote only. Members, staff and reporters alike were all caught off-guard.

Members of both parties now explain that everyone was caught between a rock and a hard place, a bad choice or a different bad choice. All want to insist that they’re for a permanent fix – but not at the expense of seniors who might be denied coverage without a “patch”, and providers who would not be reimbursed at the full level.

A permanent fix perhaps lives in the same zip code as the Tooth Fairy. Earlier in March, the House passed a $137 billion permanent fix that included an attachment to delay the individual mandate penalty for 5 years, but said attachment made Senate Democrats choose to not take it up, and also caused the White House to issue a veto threat against that bill.

Three things we wonder about: (1) what would happen if the bill gets vetoed; (2) what in Heaven’s name was the deal struck between John Boehner and Harry Reid, and (3) when you listen to the voice vote in the recording above, do YOU hear a two-thirds majority say “Aye”?

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