House Approves Bill on Changes to Medicare

The House overwhelmingly approved sweeping changes to the Medicare program on Thursday in the most significant bipartisan policy legislation to pass through that chamber since Republicans regained a majority in 2011.

The measure, which would establish a new formula for paying doctors, increase premiums for some Medicare beneficiaries and extend a popular health insurance program for children, has already been endorsed by President Obama and awaits a vote in the Senate.

The legislation, approved in the House by a vote of 392 to 37, embodies a rare and significant agreement negotiated by Speaker John A. Boehner and the House Democratic leader, Representative Nancy Pelosi of California. Both saw the value in ending a problem that has bedeviled the nation’s health care system for more than a decade, and in demonstrating that the nation’s legislative branch could function.

Mr. Obama called Mr. Boehner and Ms. Pelosi to congratulate them after the vote. “This is how Congress is supposed to work,” Mr. Obama said, addressing students at a community college in Birmingham, Ala.

Lawmakers could not immediately recall the last time a bill of such consequence had passed with a huge majority in the era of divided government, when merely keeping federal agencies from shutting down counts as a major achievement.

“Normally we’d be here to admit that we are going to kick the can down the road one more time,” Mr. Boehner said. “This is what we can accomplish when we’re focused on finding common ground.”

Marilyn Moon, a health economist and former trustee of the Medicare program, said the vote Thursday had far-reaching implications. “If doctors respond to the incentives in this bill, they will have to change the way they do business,” Ms. Moon said. “Now doctors get paid more if they do more. In the future, they will be paid more if they do it better — and may be paid more for doing less.”

Whether the bipartisan accomplishment represents a passing moment of harmony or signals a new period of cooperation remains to be seen. Many other issues, like the expiration of highway funds and an ambitious rewrite of the tax code, await.

Mr. Boehner’s strategy of working out a significant legislative compromise with Ms. Pelosi was a break from his prior attempts to mollify his most conservative House colleagues. “We are showing that we have a majority that’s working,” said Representative Paul D. Ryan, Republican of Wisconsin, “and when we see opportunities to find common ground, we are moving forward on big things.”

For her part, Ms. Pelosi, who turned 75 on Thursday, again demonstrated that even as the leader of a minority party that is sometimes restless for fresh leadership, she could win policy fights for Democrats while persuading them to compromise. Mr. Boehner lost just 33 Republicans on the bill, and only four Democrats voted no.

Democrats were pleased that the bill extended some of their favorite programs and did not attempt to roll back the Affordable Care Act, as Republicans have repeatedly tried to do. Republicans felt they had won because, as Mr. Boehner said, the bill made a start on “real entitlement reform” without the tax increases often sought by Democrats.
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Under the bill, Medicare would pay doctors based on their performance, rewarding them for higher-quality work rather than the volume of services. The Children’s Health Insurance Program would be extended for two years, rather than the four years sought by Democrats. More money also would be appropriated for community health centers, with a restriction for abortion services.

To help offset the costs, some higher-income Medicare beneficiaries would be required to pay higher premiums for coverage of doctors’ services and prescription drugs. But about two-thirds of the costs would be added to the deficit. The Congressional Budget Office estimated that the bill would add $141 billion to federal budget deficits in the coming decade, compared with existing law.

Members of both parties went to the House floor on Thursday for what was officially a debate, but sounded more like a wedding, with lawmakers speaking of the measure as benefiting elderly Medicare patients, children and taxpayers.

“It’s not a perfect bill,” said Representative Ami Bera, Democrat of California, who is a physician. “But I came to Congress to put people first. I came to Congress to work across the aisle in a bipartisan way to put our country first.”

Senate Democrats have been resistant to provisions in the bill that preserve restrictions on the use of federal money for abortion services and extend the Children’s Health Insurance Program for only two years, rather than four. House Democrats who also disliked those provisions said they got the best they could. Senator Debbie Stabenow, Democrat of Michigan, said: “That certainly was a big vote in the House. We need to look at the details.”

The lopsided vote in the House will probably help bring along members of both parties in the Senate, which is unlikely to vote before a two-week recess scheduled to start Friday. “I think we’ll have the votes,” said Senator Patrick J. Toomey, Republican of Pennsylvania.

Several conservatives expressed concern about the bill’s effects on the deficit, including Senator Ben Sasse, a freshman Republican from Nebraska, and Senator Tim Scott, Republican of South Carolina, who said the bill “is exciting for someone but not necessarily me.” Doctors face a 21 percent cut in Medicare fees on April 1 unless Congress takes action. Such a reduction would almost surely prompt some doctors to accept fewer Medicare patients. Medicare officials could stretch the deadline and delay the cuts for about two weeks.

Since 2003, Congress has passed 17 short-term bills to block cuts in Medicare doctors’ fees, which are calculated under a formula that defines a “sustainable growth rate” linked to growth of the overall economy. The Boehner-Pelosi bill repeals that formula.

Representative Michael C. Burgess, Republican of Texas and chief sponsor of the legislation, said, “From beginning to end, this bill is about access — access for our seniors, access for those who use our nation’s 9,000 community health centers and more than eight million children who receive their care at some point during the year through the Children’s Health Insurance Program.”

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