Updated 5:14 p.m. | Conservative House members confronted Speaker John A. Boehner at a private Wednesday morning meeting, fuming that last week's secret deal to pass the "doc fix" violated the trust between leaders and their rank and file.
Then, at a private meeting of the conservative Republican Study Committee later in the afternoon, members challenged Majority Leader Eric Cantor, asking the Virginia Republican to explain why leaders pushed the bill through without allowing members to cast their votes .
It remains unclear whether there will be any lasting implications to the tactic, but members are still angry and say leaders have yet to satisfy their complaints.
"What I didn’t hear was, ‘I promise this’ll never happen again.’ I think that’s something that has to happen," Rep. Steve King, R-Iowa, said. "It isn’t that anyone broke their word at this point, but they need to give their word." At a weekly morning meeting of the House Republican Conference, Boehner told the room that he wanted to have a "family discussion" about the way the vote happened. Members of both parties told the press last week that they were angry leadership passed the "doc fix" by voice vote when it was clear there were not enough votes to pass it on a roll call.
Reps. Thomas Massie of Kentucky and Louie Gohmert of Texas were the most outspoken critics of leadership's tactic at the meeting, according to sources in the room.
"There was some ventilation about it. Some members are very unhappy, claiming that it’s anti-democracy," Rep. John Fleming, R-La., said.
Massie said he was on the floor during the vote and would have objected. But the call for a voice vote happened in just more than 40 seconds, and he was caught off guard.
"I was there on the floor of the House and I did observe it, but I didn’t believe that was happening," he said in an interview. "I couldn’t grasp, I couldn’t bring myself to believe two things: One, that more than 400 members would be misled into thinking there's no vote and then for the vote to occur. The other thing I was trying to resolve is that there were clearly Democrats on the floor and they were publicly opposed to the [sustainable growth rate] … also that the Democrats were in on this.
"As I was trying to resolve all this, the gavel went down, the vote was done," he said.
Massie added that GOP staff was on the floor and celebrated as the vote was called.
"The staff were giddy, almost like they shot off a firework and ran and got away with it," he said. "It made me feel sick."
Rep. Mick Mulvaney of South Carolina also made his objections heard, although he said he toned down his rhetoric from last week, saying instead that parts of the 12-month Medicare sustainable growth rate patch are not offset for a decade, which he thinks will never happen.
"I called it bullshit last week. I did not call it bullshit today," he said. "I tried to focus today on the practical impacts of it. Put the internal politics aside, put the maneuvering aside, and say, 'OK, we just spent $6 billion that we don’t have, how are we going to pay for it?'"
In response, Boehner told the crowd that leaders had met with some of the biggest opponents of the bill — the Republican Doctors Caucus — and cleared the tactic with them first, according to sources in the room. He also said that he would have pushed forth on a permanent fix, but the price tag was too high.
He added that it was difficult enough to find the deficit reduction over 10 years in the bipartisan budget deal negotiated by House Budget Chairman Paul D. Ryan, R-Wis., and Senate Budget Chairwoman Patty Murray, D-Wash. Finding the nearly $140 billion needed to offset the permanent "doc fix," he said, proved impossible.
In the RSC meeting, Cantor also responded to the members' objections telling the room that the alternative — allowing the policy to lapse and doctors' pay to be cut by 24 percent — would have been worse.
"All of the options were bad, and it was the least bad option," Fleming said, characterizing Cantor's remarks.
That explanation is satisfying some in the conference. Rep. Renee Ellmers, R-N.C., a member of the Doctors Caucus, was livid last week about leadership's decision to bring the bill to the floor. But she said this week that she does not think there will be lasting implications.
"I do believe that leadership was just as frustrated as members were on this issue," she said. "It was just a bad situation. I just hope that moving forward we can do a better job."
In fact, sources noted that Cantor received a round of applause for addressing the conference's concerns at the weekly RSC meeting, which he regularly attends.
Others, such as King and Massie, however, said leadership has some work to do yet.
"I think that we need to now go to work to restore the trust," King said.
"I'm getting used to being deceived by the Obama administration, but when my own leaders do it, it's not acceptable," Rep. Matt Salmon, R-Ariz., said. "It was a closed door meeting, so I probably shouldn't share it, but it wasn't pleasant."
Correction: 4:42 p.m. An earlier version of this story misstated which Republican leaders had met with the Republican Doctors Caucus and cleared the voice vote plan with them.