Senate Majority Leader Harry Reid is renewing his call to use unspent war funds to spare doctors from a severe cut in Medicare payments slated to begin next month.
The Nevada Democrat told Speaker John A. Boehner of Ohio last week that he wants to use Overseas Contingency Operations funding — money saved from winding down the wars in Iraq and Afghanistan — to pay for the “doc fix," a policy that would shore up a formula that pays doctors who treat Medicare patients, according to members and staff.
The conversation came as the House began planning for a Friday vote to pay for the $138 billion fix by delaying the Affordable Care Act’s mandate that individuals purchase insurance, and further underscores that the bill will not be taken up by the Senate.
It also shows just how mired in politics the policy has become, despite a bipartisan, bicameral goal of avoiding the doctors’ pay spike. Members are starting to grumble, as a result, that Congress could end up with another temporary extension, especially because the policy must be dealt with by the end of the month. A White House statement on Wednesday noted President Barack Obama would veto the House bill if it comes to his desk, and Reid told reporters a day earlier that using the individual mandate delay to pay for the policy change has “no credibility.”
A Reid spokesman added that the majority leader would be open to other ways to pay for the policy.
Advocacy groups representing seniors and doctors piled on throughout the week. On Thursday morning, James Madara, CEO of the American Medical Association, the largest group representing physicians, sent a letter to Boehner and House Minority Leader Nancy Pelosi, D-Calif., expressing “profound disappointment” that the bipartisan policy agreement has “become a victim of partisan approaches.”
The Congressional Budget Office also handed bad news to Republicans, releasing a report Wednesday projecting that although the bill would save $31 billion, it would result in 13 million fewer people having insurance and a 10- to 20-percent spike in premiums by 2018.
Boehner defended the legislation on Thursday, saying the administration has delayed portions of the health care law, it is the “responsible thing to do” to delay any penalties on individuals who do not purchase insurance.
“The president has provided exemptions for big business. He’s pushed off all kinds of other mandates on the business side. All we’re saying is, it’s basic fairness to take away the penalty for Americans under the requirement that they have to buy health insurance,” Boehner told reporters.
Boehner also noted a Wall Street Journal report stating that in an unannounced regulatory change, the administration effectively extended the mandate’s “hardship exemption” to anyone.
Rep. John Fleming of Louisiana, a member of the House GOP Doctors Caucus, said although he supports delaying the individual mandate, the House vote could put the entire bipartisan agreement at risk.
“It may jeopardize getting this actually put in place,” he said. “Assuming that they (the Senate) reject this and it goes down, we either end up with another patch or we go back with the same bill but with a different pay-for.”
Reid’s preferred method of paying for the legislation would also likely receive heavy pushback, however. The CBO wrote last month in a letter to House Budget Chairman Paul D. Ryan, R-Wis., that unspent war funds, which are counted as discretionary spending, could not be used to offset direct spending, such as Medicare payments.
As a result, House aides said the chamber would not be open to using unspent war funds as a pay-for, and conservative outside groups have already said they deem it unacceptable. Rep Phil Gingrey, R-Ga., co-chairman of the House GOP Doctors Caucus, said although he supports the bipartisan policy agreement, he would “have an almost impossible time” voting for the war-fund offset.
Furthermore, the Pentagon's comptroller said Thursday he will not make a specific funding request for Overseas Contingency Operations until it is clear that U.S. forces will remain in Afghanistan after 2014.
Congressmen have long opposed the method as a gimmick. When the Bicameral Payroll Tax Conference Committee considered the same doc fix offset in 2012, Sen. Tom Coburn, R-Okla., and then-Sen. Joe Lieberman, I-Conn., sent a letter to Reid and Majority Leader Mitch McConnell, R-Ky., noting that the savings were “not real.” The war funding, they argued, is based on estimates of what would be spent were the nation still at war for the next decade. Because troops have already been drawn down, the money would never be spent anyway.
Alternately, members have said for weeks that the doc fix could be paid for by limiting reimbursements to health care providers, such as hospitals and nursing homes. It remains unclear, however, whether leaders want to take on those interests.